I am currently a medical student, and I wish I could divulge to you my background, education and personal life to give you the context with which I say this. In fact, I started typing it up, but have elected to delete it because even if there's only a 0.001% chance of my identity getting out, it's a risk I have no desire to take.
I have spent a long time researching the harms and long-term effects of opiate use. Even if there is no paper in the lancet that demonstrates this definitively in a RCT, I have concluded this:
with chronic opiate use, as with any chronic drug use, it's very likely that your motivation and reward pathways will be altered in a way that will affect your ability to function with your everyday life. If you take opiates but are ostensibly "functional" e.g. got a good job/studying, you probably won't even realise it's happening while you're on them. But it will be there… other things won't be as fascinating, you'll have less need for relationships. Classic anhedonia that i needn't elaborate upon.
harms to the self while taking them: taking opiates is like putting yourself in a "psychological cryostat" … there can be no personal growth while you take them. Once you stop taking them, you can now resume growing, but only as the person you were just before you commenced taking them. It's a curious phenomenon but I'm utterly convinced that it occurs.
the aftermath: In terms of drugs that can cause harms, chronic use of opiates appears to be one of the "better" ones. Moreso than say alcohol or psychostimulants. Any day of the week. But regardless of the neurotoxicity of opiates or lack thereof, you may find that the effects of your prior use stays with you for a long, long time, well after you stop taking them.
Some doors, once opened can never be closed. Now that you know what things can be like with opiates, you may never, ever, feel "normal" without opiates on board, regardless of how well you score on the WAIS-IV or how unremarkably your fMRI scan lights up.
That's the real harm with opiates.
this is not me being some new-age douche bag, and if it comes across that way, i've either conveyed my message inaccurately or your not in the headspace to understand it. if it's the latter, i bid you good luck -- experience is by far the best teacher, far, far more effective than any online discussion forum.
RE: cognition. Opiates have been shown to inhibit neurogenesis via BDNF, and may affect your memory and other cognitive abilities. There is a lot of conflicting data. Some studies have shown negative effects on healthy volunteers after acute administration, others have not. With respect to long-term use, again, conflicting data. Based upon my own data, I'd say that so long as it isn't IV, massive doses, or a stint longer than a few years, any clouded cognitive faculties should largely return after a good month's break.
correction: actually, given how long it took me to write this post, i release this was my latest round procrastination
