Recognizing effects of long-term opioid use

Older opioid practices regarding the long-term use of the analgesics could still be in use.

In an opinion article published in the Annals of Internal Medicine, investigators detailed that more than 3 million patients may be experiencing challenges with opioid use, despite adhering to their prescriptions. Recent studies have found that the long-term use of opioids may be ineffective in the management of chronic pain as a result of neuroadaptation. Compared with patients who had opioid use disorder, patients prescribed opioids to treat pain had similar adverse effects and neuroadaptation that persisted into protracted withdrawal and following drug discontinuation. These patients also reported difficulties reducing their opioid doses, even though they stated that the drugs were inadequate at managing their pain.

The investigators emphasized that changes in motivational circuits could influence regions of the brain responsible for motivation, rewards and stress responses — leading to hyperalgesia, symptoms of drug withdrawal (hyperkatifeia), reward deficiency and greater stress reactivity. These processes could increase opioid tolerance and reduce analgesia and quality of life.

The investigators urged clinicians to initiate opioid tapering conversations to educate patients prescribed long-term opioid treatment about the consequences of continuing therapy.

Read more: Annals of Internal Medicine

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