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The harmfulness of opioids

opioid opioids opiate opiates tolerance addiction dependence side effects effects adverse effects

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#1 Vieno

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Posted 03 November 2012 - 05:34 PM


We all know tolerance. But what else? If one is able to deal with the tolerance - e.g. continually increase the dose to meet the requirements of the tolerance - how does opioid use then harm the person? Note, this really is a question, not a claim of any sort.

Tolerance, dependence and addiction are always mentioned as the adverse effects of opioid use. So what are the seriously harmful effects of opioid addiction in addition to financial and social trouble caused by the constant need for getting more opioids? A lot of folks are taking buprenorphine for the rest of their life for addiction treatment, others continue to be on morphine for good because of pain. What are the cons of these treatments aside financial/social issues? Some adverse effects aside tolerance are mentioned, but they seem very small and ambiguous compared to the notoriousness of opioids.

Thanks!

Edited by Vieno, 03 November 2012 - 05:35 PM.


#2 Mr. Pink

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Posted 03 November 2012 - 05:48 PM

addiction is it. maybe the drowsiness depending on a lot of other personal factors. otherwise, they're a lot healthier than chronic tylenol use for example. but shouldn't addiction be enough of a negative?

edit: just wanted to add as to your second part about what's so bad about addiction - leads to a lot of psychological problems - anxiety, depression - basically a really bad loop that you're stuck in that makes most people extremely miserable.

Edited by Mr. Pink, 03 November 2012 - 05:50 PM.


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#3 Vieno

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Posted 03 November 2012 - 06:10 PM

addiction is it. maybe the drowsiness depending on a lot of other personal factors. otherwise, they're a lot healthier than chronic tylenol use for example. but shouldn't addiction be enough of a negative?

edit: just wanted to add as to your second part about what's so bad about addiction - leads to a lot of psychological problems - anxiety, depression - basically a really bad loop that you're stuck in that makes most people extremely miserable.


This is exactly what I'm talking about - is there anything else than addiction? I understand the psychological problems addiction causes, but does the continuous use of opioids itself do physiological damage?

Let's assume a scenario in which a person starts to use opioids and then continues to increase the dosage accordingly to the increased tolerance so that he will be in the same state as he was prior to opioid administration, e.g. in an euthymic state without euphoria, abnormal pain relief etc. The tolerance keeps growing and this person keeps increasing the dosage. What are the health effects? This kind of scenario could happen in drug rehabilitation, where one is administrated opioids only to avoid withdrawal effects and therefore stay in euthymia.

Edited by Vieno, 03 November 2012 - 06:12 PM.


#4 nowayout

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Posted 03 November 2012 - 06:11 PM

They are well known for messing up sex hormones. See pubmed. A high percentage of people on chronic opioid therapy become hypogonadic as a result. Hypogonadism is associated ith a large number of adverse effects including loss of libido, sexual difficulties, bone loss, risk of insulin resistance and diabetes, metabolic syndrome, fat gain, muscle loss, loss of motivation, depression, etc.

#5 Vieno

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Posted 03 November 2012 - 06:25 PM

They are well known for messing up sex hormones. See pubmed. A high percentage of people on chronic opioid therapy become hypogonadic as a result. Hypogonadism is associated ith a large number of adverse effects including loss of libido, sexual difficulties, bone loss, risk of insulin resistance and diabetes, metabolic syndrome, fat gain, muscle loss, loss of motivation, depression, etc.


Thanks. I have seen those things mentioned. As I'm not an expert, going through those dozends of pubmed publications is quite a big job... I would be glad to find some sort of summary for laymen. Any ideas where to look for such?

#6 Major Legend

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Posted 03 November 2012 - 07:36 PM

they are relatively benign, there isn't much neurotoxicity related to opioid to my knowledge personally, of course physical addiction is a terrifying problem for strong opiods, remember the withdrawal is physical pain and sickness itself. I have read there is no withdrawal like it, but personally as per required usage of weaker opioids is more favourable than any use of MDMA or amphetamines, since the two is linked to heavy neurotoxicity for sure.

#7 FunkOdyssey

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Posted 03 November 2012 - 07:46 PM

In addition to the negative hormonal and sexual effects, opioids are immunosuppressive, so you should see increased risk of infection and cancer.

Edited by FunkOdyssey, 03 November 2012 - 07:47 PM.

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#8 Vieno

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Posted 03 November 2012 - 07:57 PM

they are relatively benign, there isn't much neurotoxicity related to opioid to my knowledge personally, of course physical addiction is a terrifying problem for strong opiods, remember the withdrawal is physical pain and sickness itself. I have read there is no withdrawal like it, but personally as per required usage of weaker opioids is more favourable than any use of MDMA or amphetamines, since the two is linked to heavy neurotoxicity for sure.


How about the aforementioned hypogonadia? Immune system deficiency has also been mentioned in other sources like many pubmed articles: any knowledge about it?

#9 Major Legend

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Posted 03 November 2012 - 08:21 PM

http://www.ncbi.nlm....pubmed/14622741

http://www.ncbi.nlm....les/PMC1821355/

sustained use of opiates certainly causes health problems, the immune supression is well documented anecdotally in issues of heroin addicts becoming more prone to falling ill in there 40s - there was an article about a whole generation of heroin users who are now going to the hospital frequently for all these health issues showing up now they are 40

sustained opiate use should not really be considered - the above is the last thing you would be worried about, since the pain between doses would eventually become unbearable - you should read what these accounts are like its not just pain, its like feeling fire ants crawling over your skin, permanent flu and so on.

#10 nowayout

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Posted 04 November 2012 - 01:20 AM

they are relatively benign, there isn't much neurotoxicity related to opioid to my knowledge personally, of course physical addiction is a terrifying problem for strong opiods, remember the withdrawal is physical pain and sickness itself. I have read there is no withdrawal like it, but personally as per required usage of weaker opioids is more favourable than any use of MDMA or amphetamines, since the two is linked to heavy neurotoxicity for sure.


Well, I would argue that weak/strong is not really a meaningful distinction, since "weaker" opioids are often prescribed and taken in higher doses to reach whatever "morphine equivalent dose" is required.

Even if there is no technical addiction, physical dependency can easily occur in legitimate prescribed situations, and having been prescribed tramadol for an extended period and then coming off it, I definitely agree with your claim that it is very unpleasant to stop. Terrible dysphoria and akathisia, so unbearable that many people need sedation or the trauma would be too much for them. This unpleasantness can be mitigated by tapering very slowly to nothing. However, then you get a lesser unpleasantness that lasts longer, so the "integrated hardship" probably comes dwn to the same amount :-) It is so bad that I would really advise against opioids if any other options exist.

By the way, another side effect is that they tend to paradoxically make chronic pain worse, when used fr a prolonged period.

Edited by viveutvivas, 04 November 2012 - 01:23 AM.


#11 nowayout

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Posted 04 November 2012 - 02:32 AM

I am not 100 percent sure whether to classify this as a harmful effect, but opioids are a very fast and effective antidepressant for many people. This can be harmful, I suppose, in the sense that it may prevent people from developing healthy coping mechanisms. Having a bad breakup? Why deal with it if you can take some vicodin to feel better until the worst felings are past.

They are also motivation-sapping. A bad night on the singles scene and feel you're getting old and invisible and are going to die alone? Why dust yourself off and try again the next day if you can take some tramadol to kill the bad feelings and happily read longecity the rest of the weekend? As a bonus, the tramadol will turn off your libido and so also take away any sexual motivation to get out of the house. Of course, one day when you get off the drug you might regret wasting your youth this way, but that regret can be fixed by taking more... Just never get off it and you'll feel fine, as long as you keep increasing the dose, of course...

Edited by viveutvivas, 04 November 2012 - 02:35 AM.


#12 splitastone

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Posted 04 November 2012 - 07:39 PM

The longer you use opiates, the more sensitized you become to pain (including pyschological pain). You are digging a hole that is becoming exponentially deeper the longer you use. There is often a point of no return. Find another way my friend.

#13 Vieno

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Posted 04 November 2012 - 08:43 PM

The longer you use opiates, the more sensitized you become to pain (including pyschological pain). You are digging a hole that is becoming exponentially deeper the longer you use. There is often a point of no return. Find another way my friend.


What do you mean about becoming sensitized to pain? Assuming the dose is always measured to provide a normal healthy mental/physical state (taking tolerance into account), how does that sensitizion occur?
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#14 maxwatt

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Posted 04 November 2012 - 10:56 PM

I am aware of no reason to think opiates sensitize you to pain. Opiates desensitize you to opiates.

#15 nowayout

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Posted 05 November 2012 - 01:41 PM

I am aware of no reason to think opiates sensitize you to pain. Opiates desensitize you to opiates.


No, it is a well-known effect that appears to be a separate mechanism from tolerance. From Wikipedia (see their page for references):

Opioid-induced hyperalgesia[1] or opioid-induced abnormal pain sensitivity[2] is a phenomenon associated with the long term use of opioids such as morphine, hydrocodone, oxycodone, and methadone. Over time, individuals taking opioids can develop an increasing sensitivity to noxious stimuli, even evolving a painful response to previously non-noxious stimuli (allodynia). Some studies on animals have also demonstrated this effect occurring after only a single high dose of opioids.[3]

Although tolerance and opioid-induced hyperalgesia both result in a similar need for dose escalation, they are nevertheless caused by two distinct mechanisms.[4] The similar net effect makes the two phenomena difficult to distinguish in a clinical setting. Under chronic opioid treatment, a particular individual's requirement for dose escalation may be due to tolerance (desensitization of antinociceptive mechanisms), opioid-induced hyperalgesia (sensitization of pronociceptive mechanisms), or a combination of both. Identifying the development of hyperalgesia is of great clinical importance since patients receiving opioids to relieve pain may paradoxically experience more pain as a result of treatment. Whereas increasing the dose of opioid can be an effective way to overcome tolerance, doing so to compensate for opioid-induced hyperalgesia may worsen the patient's condition by increasing sensitivity to pain while escalating physical dependence.



#16 Vieno

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Posted 05 November 2012 - 02:02 PM

Ah you were talking about that phenomenon, I'm familiar with it. Wikipedia and its references are always my first choices of information sources :) Well, now that is something I can examine on my own. But how on earth is that connected to psychological pain, viveutvivas?

#17 brainslugged

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Posted 05 November 2012 - 03:22 PM

I always thought the most serious side effect in large doses is the chance of respritory depression(you could stop breathing)

#18 Vieno

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Posted 05 November 2012 - 03:52 PM

I always thought the most serious side effect in large doses is the chance of respritory depression(you could stop breathing)


Apparently this only happens via overdose and respiratory depression builds up tolerance just like euphoric effects for example. So if you adjust your dose correctly in relation to your tolerance, respiratory depression can not happen. Someone more in the know - am I right?

#19 Luminosity

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Posted 07 November 2012 - 04:03 AM

My friend has lost most of her teeth from taking prescription opioids for years. Opioids are deeply addictive so that is harmful too. They would strain the liver and kidneys, and harm the brain.

Opiate addicts (which any user can become with little warning) are often prone to infection, accidental injury and poor decisions. They injure themselves all the time and then may get infected. Opiates may worsen a tendency to run away from problems and be intolerant of stuff that people have to deal with. There's always that escape hatch that would interact with their character defects in unfortunate ways.

Don't play with harmful drugs.

Edited by Luminosity, 07 November 2012 - 04:09 AM.


#20 nowayout

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Posted 07 November 2012 - 05:49 AM

Yes, another side effect is indeed tooth decay. Opioids cause dry mouth, which can cause tooth demineralization and gum disease.

#21 Vieno

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Posted 07 November 2012 - 01:28 PM

They would strain the liver and kidneys, and harm the brain.


Could you be more specific? If there's any truth to those claims, I am very interested.

#22 medievil

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Posted 07 November 2012 - 06:31 PM

There are ways to counter the negatives, il elaborate more later.

#23 Vieno

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Posted 07 November 2012 - 07:33 PM

^^ I know there are several substances that prevent tolerance. But are there ways to counter the other mentioned adverse effects (sex hormone, immune system etc.)?

#24 nowayout

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Posted 07 November 2012 - 11:06 PM

^^ I know there are several substances that prevent tolerance. But are there ways to counter the other mentioned adverse effects (sex hormone, immune system etc.)?


Several? I see that dextromethorphan is hypothesized to help prevent tolerance, but hokw well does it really work in practice, I onder. Dextromethorphan lso has its own set of negative side effects, by the way,

What else is there?

#25 protoject

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Posted 08 November 2012 - 12:18 AM

Yes, another side effect is indeed tooth decay. Opioids cause dry mouth, which can cause tooth demineralization and gum disease.

I've seen this happen to one individual. I was wondering if opioids can cause osteoperosis as this same person had very frail bones and I don't know if it was coincidence. I remember looking it up but I'm not sure if i found anything, I'm too lazy and tired at the moment...

#26 protoject

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Posted 08 November 2012 - 01:32 AM

Oh, right, of course osteoporosis would be a result of reduced testosterone levels, however wondering if that woul dbe the only mechanism.

#27 OpaqueMind

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Posted 08 November 2012 - 04:10 PM

I can't believe nobody mentioned the long term downregulation of endogenous opioid production, that's gotta be one of the most debilitating aspects of long-term opiate use/abuse besides the addiction itself. Even once past post acute withdrawal syndrome many people say they never feel like themselves again and have severe emotional and motivational issues. All the pleasure is sucked out of life, nothing brings you joy, you're trapped in a grayscale shadow of a world and soul. I'd say that's pretty harmful to your psyche/life.

Your livers gonna be pretty fried from repeated daily exposure.

Also you have the potential excitotoxicity when stopping a habit.
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#28 Vieno

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Posted 08 November 2012 - 08:33 PM

Several? I see that dextromethorphan is hypothesized to help prevent tolerance, but hokw well does it really work in practice, I onder. Dextromethorphan lso has its own set of negative side effects, by the way,

What else is there?


Medievil knows about this stuff. I don't really know the substances or how well they work - I just know there are, yes, several, that are being investigated for their anti-tolerance effects on opioids.

I can't believe nobody mentioned the long term downregulation of endogenous opioid production, that's gotta be one of the most debilitating aspects of long-term opiate use/abuse besides the addiction itself. Even once past post acute withdrawal syndrome many people say they never feel like themselves again and have severe emotional and motivational issues. All the pleasure is sucked out of life, nothing brings you joy, you're trapped in a grayscale shadow of a world and soul. I'd say that's pretty harmful to your psyche/life.

Your livers gonna be pretty fried from repeated daily exposure.

Also you have the potential excitotoxicity when stopping a habit.


Downregulation of endogenous opioid production = tolerance. I know that the withdrawal is more than just the acute syndrome, it lasts as anhedonia for longer time. Does anybody know if the recovery continues steadily until normalized state, or does it stop after the acute withdrawal syndrome and therefore leave the endogenous opioid levels short for good?

#29 nowayout

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Posted 08 November 2012 - 10:21 PM

LDN is said to upregulate endogenous opioid metabolism, so it might be useful for cases of anhedonia after withdrawal.

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#30 Vieno

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Posted 09 November 2012 - 12:33 AM

LDN is said to upregulate endogenous opioid metabolism, so it might be useful for cases of anhedonia after withdrawal.


:) I know. Extremely well. If I'm familiar with something, it's anhedonia. But this thread is not about LDN treatment for anhedonia but about the adverse effects of opioids.





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