Opioids: A Two-
Edged Sword
Many people do not
realize that these
medications are a
two-edged sword. It
is true that opioids
are remarkable drugs.
They are simply the
best way to relieve
excruciating pain in the
short run after injury
or surgery for a few
hours, days, or maybe
even weeks.
And, for centuries they
have been easing the
agony of ailing people
for whom nothing more
can be done as the end
of life approaches.
But there is more to
the opioid story. When
taken on a regular
basis for a long time
(months or years),
these same drugs can
end up causing more
harm than good. With
prolonged everyday
use, they have actually
worsened pain and
disability for many
people who should
have been able to
resume a relatively
normal life.
of sleep. Opioids reduce the natural drive to breathe which can cause apnea (stopped
breathing). Overdose deaths are usually caused by this, especially when opioids are
combined with alcohol or other drugs.
Almost all people on opioids have constipation, sometimes severe enough to need
powerful prescriptions to treat it, and often other gastrointestinal symptoms. Many
people complain about itching and dry mouth. Liver damage, bone thinning, and
weakening of the immune system (immunosuppression) are other side effects.
Impact on Safety and Employment
The side effects listed above can significantly impair performance of safety-sensitive tasks
such as operating a motor vehicle or dangerous machinery -– whether at home, at work,
or in the community. Opioid users are often unaware of their own impairment even though
the consequences may be severe. Those whose jobs are safety-sensitive such as drivers
and public safety workers are often denied medical clearance if they are using opioids.
Risk of Death
According to the Centers for Disease Control and Prevention, the United States is
in the midst of an epidemic of drug overdose deaths mostly due a rapid increase in
opioid-related overdoses. Today, more people are dying from drug overdoses than
from motor vehicle crashes. Since 2000, roughly a half million people have been killed
by a drug overdose. The number dying each year due to opioid overdose has more
than tripled. In 2014, more than 47,000 people were killed by drug overdoses of all
kinds. Of those, the largest group (28,000 deaths) were due to opioid overdoses. That
is 78 lives lost per day and the highest number on record. Death is more likely when
opioids are combined with other medications, illicit drugs, or alcohol. Prescription
opioid overdoses now outnumber deaths due to heroin and/or cocaine, combined.
Why do deaths due to overdoses of prescription opioids occur? Usually people stop
breathing because of accidental overdose. There are several ways that happens.
People on very high doses sometimes overdose by mistake, and sometimes die
with no obvious cause. There are deaths among young children who put everything
they find into their mouths. Teenagers and young adults take some of their parents’
or grandparents’ medications to get high. Adults may take a friend’s medication,
purchase drugs on the street, or steal them. They don’t realize they have taken too
high a dose—and stop breathing.
Risk of Addiction
Physical dependence, tolerance and addiction to opioids are three separate issues.
Everyone who uses opioids will soon become physically dependent on them and have
withdrawal symptoms if the dose is abruptly lowered or stopped. Tolerance is common
but not universal. It means that over time, higher and higher doses are required to get
the same effect. But some people also become addicted. No one can predict for sure
who is vulnerable or when the shift to addiction will occur.
Addiction is related to physical dependence but is a bit different. Because opioids
affect the brain’s reward/pleasure center, a craving develops that goes beyond the
relief of pain. It may be subtle. When addicted, people don’t use their drugs the way
the doctor prescribes.