Risks of long-term opioid treatment

In the first installment, A balancing act – opioid use throughout history, we reviewed some historical highlights to help us understand how we arrived at the present situation. Now we’ll cover many of the potential side effects and risks of long-term opioid treatment.


Opioids are not recommended as first-line migraine therapy. They are usually prescribed for those who cannot tolerate or do not respond to other therapies. A study was published in the January 2012 issue of Headache in which researchers analyzed data from AAMP regarding opioid use1.

Study results

Here is a summary of what they discovered:

  • 70% of those studied had not ever used of opioids
  • 13% previously used opioids
  • 2% currently used opioids and were not dependent
  • 6% currently used opioid and were probably dependent
  • Those who used opioids were more likely to be
    • older
    • be single
    • unemployed
    • have higher BMI
    • have lower income
  • Headache disability among opioid users

None of these findings established a causal link1. In fact, it is just as likely that the higher rate of negative outcomes was a result of the disease itself. Those patients more likely to use opioids may simply be more disabled by Migraine.

Side effects

Not everyone will experience every side effect and some people will experience side effects not documented. Some side effects get better with time and some don’t. Sometimes these side effects do not go away once the opioid is discontinued1.

  • Euphoria
  • Sedation
  • Sleep disturbance
  • Respiratory depression
  • Cough suppression
  • Papillary constriction
  • Truncal rigidity
  • Nausea & vomiting
  • Temperature dysregulation
  • Lowered seizure threshold
  • Bradycardia
  • Hypotension
  • Constipation
  • Gastroperesis
  • Renal function depression
  • Itching
  • Immune system suppression
  • Endocrine system suppression

After two weeks of continuous use

  • Tolerance occurs
  • Potency is reduced
  • Cross tolerance occurs
  • Constipation & GI slowing does not improve with continued use
  • Respiratory depression may worsen
  • Patients may escalate use, leading to psychological dependence
  • Withdrawal symptoms begin 6-12 hours after cessation and last for 2-3 days but, cravings can continue indefinitely.
    • Rhinorrhea
    • Lacrimation
    • Altered thermoregulation
    • Pupil dilation
    • Generalized pain
    • Vomiting
    • Diarrhea
    • Anxiety
    • Agitation

It is also important to note that the new DSM-V has replaced both Opioid Dependence and Opioid Addiction with a new diagnosis, Opioid Use Disorder1.  In order to meet the diagnostic criteria, patients must exhibit “problematic pattern of opioids use leading to the clinically significant impairment or distress, as manifested by at least 2 of the following, occurring within a 12 month period:”

  • Opioids taken in larger amounts of over a longer period of time than was intended
  • Persistent desire or unsuccessful efforts to control or cut down opioid use
  • A great deal of time is spent using, obtaining, or recovering from effects
  • Craving
  • Failure to fulfill major role obligations at work, school, or home
  • Continued use despite problems because of opioids
  • Important activities are given up
  • Recurrent use in situations that are physically hazardous
  • Continued use despite knowing of physical or psychological problem because of opioids
  • Tolerance (unless used under “appropriate medical supervision”)
  • Withdrawal (unless used under “appropriate medical supervision”)

Please note that just because a patient is under a doctor’s care does not mean that addiction cannot occur. According to the new criteria, only tolerance and withdrawal are exempt from inclusion if under medical supervision. If a patient is taking opioids and then putting themselves in situations that are physically dangerous (such as driving or operating heavy machinery) AND that same patient continues to take higher and higher doses over time to achieve the same effect, he or she may still be considered for drug addiction treatment.  It’s a hazy area that is largely a judgment call.  No two patients are alike. The important thing is for both patient and doctor to communicate openly and honestly so that medical decisions are made in the best interest of patient well-being.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
View References
  1. Healthcare Professionals Network, (March 21, 2012). Looking at the big picture of opioid treatment for migraine, Pain Managment, retrieved 2/15/2015 at http://www.hcplive.com/publications/pain-management/2012/march-2012/Looking-at-the-Big-Picture-of-Opioid-Treatment-for-Migraine.

Comments

View Comments (8)
  • Niamhor
    4 years ago

    Hello, Tammy. Thanks for the info. Could you please say a little more about the “data from AAMP”? For instance, how was the data collected, and over what time period? Oh, btw, does AAMP stand for American Association of Medical Personnel? Thanks a lot. (-:
    Niamhor

  • Julie
    4 years ago

    I’m looking forward to the additional parts of this series. I am one that after 12 years of countless failures of an array of medications, we turned to opioids .. and not lightly. They have been a true god send for me and I now have a quality of life. There are safe guards that to need to be in place and constant monitoring. I am on a very low dose and have been fortunate to have this dose remain effective… I understand this is not the norm. You have to be honest with your doctors and be open with loved ones .. pretty much an open book all the time but it’s well worth it. I understand I’m in a very small minority but I’ll continue to fight for this treatment. It’s a matter of me having being able to LIVE my life not just suffer through it.

  • Hillary
    4 years ago

    After having two hip replacements by 40, my son-in-law became addicted to opioids, and subsequently died. His death was attributed directly to the opioids and additional use of Tylenol. He was taking 30-40 daily. Because of this I am extremely cautious. I have refused them in the ER. I cannot use any NSAIDS, either.

  • Hope
    4 years ago

    Very interesting. I read this and think wow I am in two percent? I can not take triptans due to health issues so take preventatives, verapamil … Several vitamins/minerals but do alternate between Fiorecet and Fiorecet with Codeine depending on pain level. I have a great doctor who works with me to look at all areas of my life and health. By the grace of a God, this has worked for decades without increase. I asked my hubby years ago to make sure I do not overdo. He is often the one reminding me it is better to take the regular Fiorecet to nip things in the bud so I don’t need the one with codeine. No, I do not fit any of the other criteria. I am married, work, and try hard to learn all I can and be healthy. Like I told my doctor, who wants to be constipated and not under total control? Perhaps, some genetics lead to a propensity to addiction certain people? Hoping that like other women in my family once I am done with the change of life I can bid these all Bon Voyage.

  • Hope
    4 years ago

    Notice I made a typo, not sure how to edit to take out the word a in front of God.

  • RobertCan
    4 years ago

    Before engaging a Neurologist, my PCP prescribed Hydrocodone as a rescue drug to be used only when triptans failed. Something to keep me out of the ER. For me, this approach rarely worked.

    Recently, I underwent significant oral surgery and was on hydrocodone for approximately a week following surgery. It was the first time in months I managed to go five consecutive days without a migraine. Does the credit go to my opioid? Sure makes me wonder.

    Wishing you all a pain-free day – robert

  • RobertCan
    4 years ago

    Sounds good, Tammy. Looking forward to the rest of the series!

  • Tammy Rome author
    4 years ago

    Keep watching you in-box for more. I think you will learn a lot, but don’t want to post any “spoilers” as this is only the 2nd in a five-part series. I hope you learn as much as I did while researching and writing this series.

    Best wishes to you, too! ~ Tammy

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