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What Taking Opioids Every Day Does to Your Body

Here's what the painkillers do biologically.
FACT CHECKED BY Emilia Paluszek

I am a practicing addiction psychiatrist in New York City and research scientist funded by the NIH. With these twin lenses of clinical and research perspectives on long-term opioid use, I have learned a lot about how opioids can impact someone's psychology and physiology. The current opioid crisis is now largely attributed to widespread increases in the prescribing of opioid painkillers starting in the late 1990s. Over the past two decades, I've treated patients in my clinical practice who have become addicted to opioids (including heroin and fentanyl) but that is not the same thing as taking opioid-based medications as prescribed for pain conditions. And addiction is also very different from taking opioid-based medications for the treatment of opioid addiction. Opioid molecules themselves are not inherently toxic to the body or mind, unlike alcohol for instance. However when opioid use becomes erratic and recklessly heavy, or involves dangerous forms of administration, such as smoking or injecting, then users are more likely to experience harms. Finally, there is a critical distinction between prescription medications from a licensed pharmacy and drugs from the black market. Black market drugs are now more contaminated than not and you cannot tell by appearance alone what a pill or powder actually contains, no matter how "real" it looks. Read on to find out more—and to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.


They Make You Feel Good

happy couple toasts wine glasses on beach

Opioids mostly work on the parasympathetic system. The simplest way to think about it is that our autonomic nervous system is comprised of two opposing but complementary systems- similar to a ying-yang or the Janus mask of comedy and tragedy. In this context, the parasympathetic side is the cooling, relaxing, zen side whereas the sympathetic system is the fight, drive, appetitive and revved up opposite. When the parasympathetic system is more active, it is like relaxing at the spa or enjoying a beautiful vista. Opioids preferentially enhance these feelings and processes in the body.


They Make Pain Go Away

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There is one specific benefit in the contemporary medical use of opioids in the Western world: analgesia. Analgesia is pain relief. This pain relief can include effects that blunt the processing of pain so that it is not as intense, and it can also include alterations in mood and emotional processing of pain signals and concerns (i.e. fear and anxiety) related to the experience of pain. Opioids are incredibly powerful painkillers and they are especially effective in acute settings such as on the battlefield and in surgery. They are also often used in end-of-life care, such as for patients with debilitating conditions or on painful chemotherapy.


They Make You Feel Euphoric

Smiling young man carrying woman on his back and laughing outdoors

Another effect of opioids that is well known is euphoria. Euphoria will arguably be more intense for people who recreationally use opioids or take more than prescribed, especially in the absence of a legitimate medical condition or when taking them in combination with other intoxicants that boost their euphoric effects. For some recreational users, "getting high" is the goal. For others, they report that using opioids "was the first time I ever felt normal," suggesting that some people may biologically under-produce endogenous opioids. In which case the use of opioids may be more like treatment for neurochemical imbalances rather than drug abuse per se.


You May Feel Nausea

Woman Suffering From Nausea

Because everyone is unique, everyone will have slightly different reactions to opioids. While analgesia and euphoria are two well known effects of opioid use, there are other symptoms that can be very uncomfortable—in particular, nausea (even vomiting) and sedation. Probably 20-30% of people actually dislike the effects of opioids. This arguably deters them from using opioids and can be protective against developing opioid addiction. However these effects, or mix of effects, can evolve over time as people gain tolerance.


They Make You Constipated

Door knob on or off the bathroom

Constipation! The gastrointestinal tract is lined with opioid receptors.This is why some people develop nausea and vomiting and others, especially with long-term opioid use, develop constipation. While constipation can clearly be uncomfortable, it can also be deadly. Especially in the inpatient setting, a lot of medical care can be dedicated to a "bowel regimen" to make sure patients are able to continue having regular bowel movements otherwise there can be serious health risks.

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They Can Give You Breathing Disorder

woman makes inhalation nebulizer at home

The news media and CDC have garnered a lot of attention for covering overdose rates in the US in recent years. Unfortunately one of the effects of opioid use is respiratory suppression. For novice users, this might not even require a high dose, especially if opioids are taken with other sedatives like benzodiazepines, sleeping pills, or alcohol. For long-term users, many people will have a high tolerance, but an abrupt increase in dose, or being exposed to something like fentanyl which is highly potent, can still be lethal.

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What to Do if You Become Addicted

man holding a glass of alcohol and a handful of pills

No one ever intends to get addicted. Addiction is literally the complete loss of control over taking a particular substance, and for opioids this can be especially destabilizing. Individuals often struggle with shame and try to conceal their problems. The most important thing is to seek professional care from licensed specialists. In particular, medication based treatment with FDA approved medications such as buprenorphine, methadone, or naltrexone have the best evidence for improving outcomes and saving lives. These days, medication treatment is more available than ever in part because of recent reforms that have expanded access to discrete and convenient telehealth services. 

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What You Should Do if You Notice These Signs

Mature doctor wearing uniform speaking at camera

Talking to a medical professional, either a pain specialist or an addiction specialist depending on the circumstances, is the most important thing to do if you notice problems from opioid use. There are many ways to help people who have problems with opioids or who have inadequately treated pain. There is no need to suffer alone. And to protect your life and the lives of others, don't visit any of these 35 Places You're Most Likely to Catch COVID.

Arthur Robin Williams, MD, MBE
Arthur Robin Williams MD MBE, Medical Director, Ophelia Health Read more about Arthur Robin
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