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What Are the Effects of Long-Term Opioid Use

Medically reviewed by Alyssa Peckham, PharmD, BCPP — By Rachel Nall, MSN, CRNA and Kelly Morrell on October 25, 2022Opioids are a type of medication doctors primarily prescribe for relieving pain associated with surgery, cancer, or injuries. Opioids can provide a lot of therapeutic benefits, but they do come with some side effects. While their short-term effects are relatively well known, the effects and risks of long-term opioid use are less clear. This is partly because there’s no formal definition of what’s considered “long-term” use. Some experts define taking opioids for 3 months or longer as long-term use, but others consider a few weeks to be long-term use. Here’s a closer look at what experts do — and don’t — know about the effects of long-term opioid use.

How opioids work

Before getting into the effects of long-term opioid use, it’s important to understand how opioids work in your body. Your body’s cells contain receptors. These receptors are a lock of sorts. Certain molecules can unlock them. Opioid receptors are found in nerve cells in your brain, spinal cord, stomach, and some other body parts. Opioids activate these opioid receptors. In response, the opioid receptors block the transmission of pain signals from the nerve, providing significant pain relief. Examples of opioids include:codeine fentanylhydrocodone meperidine morphineoxycodone

Opioid side effects

Opioid receptors have pain-relieving abilities, but they cause other effects on the body, too. These include:drowsinessdizzinessfeelings of euphorianauseavomitingconstipationslowed breathing rate If you take opioids as prescribed by a healthcare professional, these side effects typically aren’t a cause for concern. But taking more than prescribed, or more than your body is accustomed to, can result in an overdose (more on this later).

Effects and risks of long-term opioid use

Experts don’t fully understand the effects of long-term opioid use, partly because there’s no agreement about what constitutes long-term use. Some potential effects associated with long-term opioid use include:adrenal insufficiencycentral sleep apnea hypogonadismosteoporosistremorsworsening gastroesophageal reflux disease (GERD) symptoms Long-term opioid use may also lead to a rare condition called opioid-induced hyperalgesia (OIH). People with OIH become more sensitive to pain over time while taking opioids. Some research also suggests that some opioid medications may suppress your immune system, increasing your risk of infection.

Tolerance and dependence

Over time, your body may develop a tolerance to opioids. That means you will need to take an increasingly higher dose of opioids to feel the same effects you once did with a lower dose. Eventually, your body may also develop a dependence on opioids to function. If you stop taking opioids after developing a dependence, you will experience withdrawal symptoms.

Opioid use disorder

Opioid use disorder (OUD), sometimes called opioid addiction, can happen with or without dependence. OUD involves repeated use of opioids despite significant negative effects. These effects may be physical, psychological, or social. Potential symptoms of OUD include:difficulty decreasing your opioid use despite a desire to do soexperiencing strong urges to take opioidscontinuing to take opioids despite negative impacts on your obligations at work or homespending significant time trying to obtain opioids or recovering from their effectsexperiencing withdrawal symptoms when you stop taking opioidsdeveloping a tolerance to opioids Keep in mind that the “Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5)” doesn’t consider withdrawal or tolerance to be symptoms of OUD if you’re taking opioids as prescribed by a healthcare professional. It’s also worth noting that OUD occurs on a spectrum that ranges from mild to severe, depending on your symptoms. If you think you might be experiencing OUD, talk with a healthcare professional about treatment options. Medication-assisted therapy (MAT) is a particularly effective option. It involves a combination of medication and therapy. Medications that might be used in MAT include:buprenorphinenaltrexonemethadone

Safety tips

It’s possible to experience opioid overdose regardless of how long you’ve been taking opioids. That said, long-term opioid use is linked to a higher risk of overdose. Signs and symptoms of an opioid overdose include:small pupilsslow or ragged breathingblue or gray fingertipsa loud, rattling snoring sound when breathingnausea or vomitingpale or ashen, clammy skin that’s cool to the touchdozing off, even when trying to stay awake If you suspect someone is having an opioid overdose, call 911 or your local emergency number right away. Stay with the person until help arrives. You may also want to consider keeping some naloxone nasal spray around and making sure someone close to you knows how to administer it. Naloxone (Narcan) can reverse an opioid overdose. Ask your pharmacist about naloxone availability in your area. NEXT Distro can also help you find naloxone in your area and even send you some by mail. It’s especially important to have naloxone on hand if you or a loved one takes opioids from a nonpharmaceutical source. These opioids may be contaminated with strong synthetic opioids that can increase your risk of overdose. Here are a few other tips to keep in mind while taking opioids:Avoid mixing opioids with other substances that act as depressants on your central nervous system, like alcohol and benzodiazepines.Keep your doctor in the loop about your pain levels and side effects. Don’t increase or decrease your prescribed dose without talking with your doctor first.

Takeaway

There’s no formal distinction of what constitutes long-term opioid use. Plus, everyone reacts to opioids differently. As a result, it’s difficult to get a complete picture of the effects of long-term opioid use. However, long-term use does appear to be linked to a range of health effects. If you’re concerned about how long you’ve been taking opioids or feel like you want to cut back your dose, talk with your prescribing doctor. They can help you find an alternative medication or work with you to taper down your dose. You can also reach out to one of the following free and confidential resources:SAMHSA’s National Helpline at 800-662-HELP (4357) or online treatment locatorSAFE Project Last medically reviewed on October 25, 2022

How we vetted this article

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jamanetwork.com/journals/jamanetworkopen/fullarticle/2738029Huynh P, et al. (2021). Long-term opioid therapy: The burden of adverse effects.
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asahq.org/madeforthismoment/pain-management/opioid-treatment/what-are-opioids/Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Current Version Oct 25, 2022 By Rachel Nall, MSN, CRNA, Kelly Morrell Edited By Kelly Morrell Medically Reviewed By Alyssa Peckham, PharmD, BCPP Copy Edited By Sara Giusti Share this articleMedically reviewed by Alyssa Peckham, PharmD, BCPP — By Rachel Nall, MSN, CRNA and Kelly Morrell on October 25, 2022

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