Many people find themselves taking opioids for the painkilling effects, but the line between legitimate medical applications, and recreational and addictive use, can be very thin. For people who take their opioids beyond the recommended limits, the long-term effects of the use can include severe and life-threatening damage to the brain and body.
How Do Opioids Work?
In and of themselves, opioids are not harmful. In fact, the human body has its own opioid system, which is designed to control pain. When a person takes natural or synthetic opioids, the molecules in that substance activate the opioid receptors by binding to them. The activation releases neurotransmitters that not only dull pain signals coming in from the central nervous system, but also sends signals that activate feelings of reward and pleasure. This is why human beings have used naturally occurring opioids like the poppy plant for millennia. As much as chewing, smoking, and drinking the tea of the leaves was useful in alleviating pain, it also made people feel calm, relaxed, and happy. The encyclopedia Britannica notes that this is because opioid molecules slow heartbeat and respiration, even smoothening gastrointestinal muscles.
Opioids are not dangerous in and of themselves, but they can become a source of risk quite easily. Some people are more psychologically, genetically, and environmentally prone to compulsively seeking out the euphoric effects of opioids or other substances, and modern-day pharmaceuticals that are derived from the morphine in the poppy plant are engineered to be infinitely stronger and more effective than their natural counterparts.
This has meant that millions of people have benefitted from the painkilling effects of opioid-based drugs. For example, chronic pain and cancer pain have become far more manageable than they were in the past, and opioids are widely used in the treatment of injury and post-surgical pain. Unfortunately, this also means that the temptation to take opioids over a long period of time is almost irresistible for people who want better pain control or who find the euphoric effects impossible to resist.
Developing a Tolerance
These particular opioids – everything from prescribed medications like OxyContin and Vicodin, to completely illegal drugs like heroin – bind to the opioid receptors and activate them so fully that the flood of neurotransmitters completely overwhelms the brain. It dwarfs any comparable activity or process that dulls pain and induces feelings of happiness, such as exercise. For people inclined toward the risk factors of addiction, the explosion of pleasure and comfort has such a pull that they desperately try to recapture the initial sensation. However, one of the many pitfalls of addiction (and all the more so with opioid abuse) is that each subsequent exposure to the substance yields a diminishing result.
This is because of an effect known as drug tolerance. Simply put, the more of a substance a person consumes, the more the brain adapts to that level of the drug. In time, increasing amounts of the drug are needed to try and hit that same point even as the brain cannot realistically respond the way it did at first. People who are craving the euphoria or analgesic effects cannot easily discontinue their compulsive need. Even as the threshold for the desired effect keeps rising, they relentlessly pump their bodies with heroin or oxycodone, loading up their brains and central nervous systems with dangerous amounts of opioids.
How Does it Affect the Brain?
Over time, the brain’s perception of everything from reward to pain management becomes fundamentally distorted. In the long-term, the constant exposure leads to the body losing its ability to fight discomfort on its own because its own pain-fighting neurotransmitters become buried under the opioid molecules. Even trivial injuries might cause significant distress, which an addicted person will likely attempt to address by consuming more opioids and deepening the spiral.
Since the affected neurotransmitters are also part of the mood and emotional responses, a long-term user of opioids will similarly struggle to experience natural and healthy expressions of happiness and comfort. As with most forms of addiction, hobbies, family, and social activities will suffer, partly because the need for more opioids becomes an obsession in the person’s life, and also because no other activity causes the same kind of neurotransmitter production as feeding the opioid need.
What Dependence and Withdrawal Look Like
This kind of opioid use builds up until the person becomes physically and psychologically dependent on the medications to maintain even basic functioning. Depriving them of their opioids induces strong feelings of sickness, to the point where opioids are needed just to feel some semblance of normal.
These are known as withdrawal effects, which are the result of numerous systems responding frantically to the sudden deprivation of the opioid molecules that had hitherto been running rampant. The brain and central nervous system cannot simply revert to their pre-opioid state, and instead send out a flood of neurotransmitters and other chemicals in an attempt to find equilibrium. This has been likened to a seesaw moving up and down when a weight is suddenly removed before finally coming to a rest.
Speaking to the Minnesota Post, doctors and former heroin addicts described the range of effects that users might feel if they attempted to withdraw from long-term opioid use:
- Severe depression
- Sleep disruptions
- Nausea, vomiting, and diarrhea
- Flulike symptoms, such as fever, chills, and cold sweats
- Panic and anxiety attacks
- A deep craving for more opioids to alleviate the discomfort of the symptoms
Dealing with Long-Lasting Damage
Long-term opioid use can be incredibly damaging to the brain, and the effects of this damage can last for years after the final exposure to an opioid. Some people in recovery admit to never feeling entirely like themselves, even as they benefit from a life free of opioid abuse. MRI scans have showed “brain dysfunction associated with heroin addiction […] even after at least three years of abstinence,” according to the Journal of Neuroscience Research. Researchers found that recovering addicts still had a desire for heroin, notwithstanding completing therapy and maintaining their abstinence, concluding that people who abuse heroin could struggle with a long-term risk of relapse even if they do all the right things for their recovery.
Commenting on the Journal of Neuroscience Research study, Medscape noted that exposure to a powerful opioid like heroin can cause permanent brain damage, and that the damage is not simply “fixed” after a patient stop taking heroin and goes through treatment. This means that people recovering from long-term opioid use have to have multifaceted approach to maintaining their sobriety, which can include medication-assisted treatment, continuing therapy, and regular aftercare support.
Chronic Abuse and Bowel Issues
When taken for too long, opioids cause severe damage to the brain and psychological functioning, but such drugs can also affect how the body operates. As Britannica noted, the activation of opioid receptors can smoothen gastrointestinal muscles; if the opioid use persists, this can lead to a condition known as opioid-induced constipation. Also known as OIC, this is a potential side effect of any form of opioid consumption, but it becomes a very likely health risk if opioids are consumed to the point where this regularly happens.
Medically speaking, constipation is a when the passage of stools through the intestines slows down. It also refers to when stool is hardened to the point where it is painful to pass. There are many causes of constipation (some serious, some benign). Opioids slow down, or completely stop, the muscles around the intestines from squeezing and expanding to push stools through the gut. Additionally, the intestines are designed to absorb water from the stool as it passes through the gut; this lubricates the intestines and allows for a smooth journey. Too many opioids over too long a period of time, however, and the intestines absorb so much water that the stools become hard, dry, and difficult to move and eventually pass.
With continued opioid exposure, the muscles of the stomach might become paralyzed, so much so that the necessary digestive secretions do not take place. Users might not only have difficulty passing stools, they might not even feel that they have to even though their stools are building up inside them. Without regular bowel movements, patients might develop hemorrhoids, anal fissures, fecal impaction, and rectal prolapse. Symptoms of all these conditions include cramping, severe pain in the abdomen, lower back pain, and bleeding from the anus.
How it Leads to Respiratory Depression and Failure
The long-term effects of opioids on the bowels are significant, but it is the damage they do to the respiratory system that is behind most of the overdoses and fatalities that are related to opioid use. As opioids depress the central nervous system, they directly interfere with the body’s breathing mechanisms. Over time, vital organs are starved of oxygen, risking shutdown and failure of key bodily systems. For example, users can be so heavily sedated that even when they are deprived of oxygen, they cannot wake up to draw breath. This is the pattern behind most forms of opioid overdose.
Similar to how long-term opioid exposure reduces the urge to pass stools, a person taking opioids for a considerable period of time will even lose the natural urge to keep breathing as an automatic reflex to draw oxygen. Even prescribed doses of opioids can pose problems to the respiratory system, so a person taking higher-than-normal amounts of opioids, or taking opioids for longer than necessary or advisable, will reach a point where drawing breath becomes a physical effort.
This situation describes respiratory depression. As the brain does not get the oxygenated blood it needs to operate, and struggles to perform even the most basic function as breathing, the patient will experience agitation and disorientation, which can compound other effects of long-term opioid use.
Taken to its extreme, the patient experiences respiratory failure. The opioid receptors are drowning in opioid molecules, to the point where the body’s natural breathing reflex is almost completely suppressed. With such perilously low levels of oxygen, patients will likely lose consciousness. Unless they receive an emergency supply of oxygen, there is a strong chance of permanent brain damage, coma, or death.
How Long-Term Use Impairs Sex Drive
With the physical effects of long-term opioid use, people who take more opioids than they should are at risk for damaging their sexual drives and functions. Studies have found that 20 percent of patients who took high amounts of opioid medication, for long periods of time, struggled with sexual dysfunction. Researchers theorized that opioids decrease the production of sex hormones (testosterone and estrogen) much like the way opioids decrease neurochemical activity related to bowel movements and breathing.
The warning was picked up by the Food and Drug Administration in 2016, which stated that opioid pain medications could be implicated in patients suffering from a reduction in the hormones that influenced sex, impotence, and fertility. Even before that, in 2013, the Spine journal discovered that men who were on opioid therapy pain management were more likely to also use treatments for erectile dysfunction. Most research has looked at the effects of long-term opioid use on men’s sex drives, but the Journal of Clinical Endocrinology and Metabolism found that opioid use also harms adrenal androgen production, which some women will experience as a loss of interest and pleasure in sex, via vaginal dryness, which results in painful intercourse. However, the effects are more acutely felt in male patients than in female patients.
How can these be Treated?
Most of the long-term effects of opioid abuse can be addressed through treatment, although the damage done can last for years. Additionally, some psychological or physical functioning might be permanently altered, and a recovery team (healthcare professionals, counselors and support groups) will help the patient accommodate for their new reality.
For people who have been using opioids for a long time, simply taking the drugs away will cause harmful withdrawal symptoms, which themselves can be dangerous if left untreated. The accepted option is medication-assisted treatment, or MAT, where patients are put on a course of milder, slower-acting opioids. This will allow them to avoid the worst of the withdrawal symptoms while gradually reducing their psychological dependence on stronger opioids.
MAT alone has been so effective in reducing strong opioid abuse that some studies have suggested it can render talk therapy, like Cognitive Behavioral Therapy, obsolete. However, most doctors believe that medication on its own is not sufficient for a complete recovery; therapy is needed to address the emotional and mental health damage done by opioid dependence. Mental health programs can also help clients repair relationships with friends and family members, and rebuild bridges of trust and communication that were destroyed because of the addiction. Even if medication-assisted treatment works in getting a person to stay away from powerful opioids, the mental health processing of therapy and counseling is invaluable for recovery.
The Importance of Ensuring Recovery
When formalized treatment is completed, a person in recovery can join a peer-support program, like Narcotics Anonymous. Based on the 12-Step model, these groups provide accountability and support for former opioid addicts who are learning how to live without the constant presence of opioid drugs or medication. The people in these groups know what long-term opioid use looks like, and this solidarity is invaluable for those in the early stages of recovery. However, recovery is always a possibility. With diligent treatment, hard work, and support, it is possible to live a balanced life after an opioid problem.
Recovering from long-term opioid use is not easy, and some of the changes the abuse brings about could last for years or even a lifetime. However, recovery is always a possibility. With diligent treatment, hard work, and support, it is possible to live a balanced life after an opioid problem.