Adding anything to the discussion on opioids is fraught with danger. It is a highly politicised and increasingly moralised debate. But here’s something worth knowing about. The current opioid problem has been decades in the making, dating back to (but of course not solely caused by) a dodgy piece of science published in a vanishingly brief letter to the New England Journal of Medicine. Nearly 40 years later, the NEJM published a further piece that highlighted the scope of the problem:
“In conclusion, we found that a five-sentence letter published in the Journal in 1980 was heavily and uncritically cited as evidence that addiction was rare with long-term opioid therapy. We believe that this citation pattern contributed to the North American opioid crisis by helping to shape a narrative that allayed prescribers’ concerns about the risk of addiction associated with long-term opioid therapy”
Something else worth knowing about is the potent effect that opioids have on our immune system and the resulting, paradoxical increase in sensitivity and pain that can ensue. A large body of literature is now available on the phenomenon of Opioid Induced Hyperalgesia (OIH). Some useful, open access papers here and here to give you some of the science.
It can be a confusing, dangerous issue for patients – they need reliable information and a good medical team to help with decisions. Here’s how you might go about starting a conversation:
Nugget #57 Morphine Madness
Most people get a few hours of pain relief from morphine [or insert other opioid name]. However, when it comes to persistent pain, morphine is a bit of a problem. There are two reasons for this – one is that it is addictive and some people start to crave it. The other reason involves the biological effects that morphine has on our danger pathways. While morphine dampens down danger messages in the central nervous system, thus decreasing pain, it also activates immune cells that can make the danger pathways more efficient. This will normally increase pain. Over time, the balance between the anti-danger effect and the pro-danger effect shifts towards an overall danger effect. In this situation, the morphine is actually making the pain worse.