Watch Out: Before you take an opioid for your pain

In a terrific review article in the journal, Pain, G Mazereeuw and 2 other authors review some of what we know about opioid drugs and their review is really devastating.

Among the well-known potential serious complications associated with opioid use, they cite addiction, overdose, and death, which is news to no one, I think. (I would also add self-harm and harm to others including family to that list of awfuls).

However, what may be a bit more surprising to many are some of the less well-known – what the authors call “subtler” – risks of opioids which include, according to this review, an increased risk of falls, fractures, and motor vehicle collisions; testosterone suppression, which can in turn lead to infertility in both men and women; and the very curious situation in some patients in whom the use of opioid drugs can paradoxically worsen pain, particularly when these drugs are used at high doses, something that’s done far too frequently.

And most interestingly, I think, these authors go on to suggest that depression may also be a little-known risk of using opioid drugs.

The reason that’s such an interesting suggestion is that for pretty obvious reasons, chronic pain has long been known to be a driver for the risk of depression but these authors are suggesting that at least in some people, it’s not the pain but rather the treatment of the pain that is causing their depression.

Bottom line: Although useful for some patients and in some situations, on the whole, in the real world right now, opioids are way over-used and cause a great deal of side effects and complications without really improving the lot of so many people who start using them.