New Research Shows Opioid Overuse Harms Hormone Levels

It seems like every year we hear about another adverse side effect of pharmaceutical opioid drugs. Yes, there is the rampant death toll from these drugs. The fact that pills are supposed to help people and instead end up killing them is a frequent headliner in news and media. Thousands of people die from overdoses of opioid pills every year.

But we also have to contend with the other adverse side effects of these drugs. Addiction and chemical dependence, tolerance of the drug and overdose—these are the typical phenomena we associate with opioid pills. But a new study shows that opiate pills also significantly drop hormone levels in men. That’s a previously unheard of side effect that forces us to question, once again, if these are pills that we want to be consuming.

Hormones and Opioids

According to new research by the Leiden University Medical Center in the Netherlands, the long term overuse of opioids can lead to hormone deficiencies in men. The research was a survey of medical literature combing the results of many case studies. The analysis showed that two-thirds of men who used opiates for more than six months developed a health condition called “hypogonadism.” Hypogonadism is a condition involving insufficient testosterone production.

Dropped hormone levels is nothing to palm off. It might not sound like a serious condition, but it can be. For example, one in five of the men in the Netherlands study group were found to be severely lacking in Cortisol as a direct result of ongoing opioid use.

Cortisol is not only a stress-related hormone, but it also helps to regulate metabolism. When Cortisol levels drop off, it brings about severe problems in both an individual’s mental and physical condition. Psychological distress, fatigue, mood swings, muscle loss, weight loss, lowered sex drive, and muscle weakness are just some of the phenomena one experiences when Cortisol levels drop. And that is only one of the hormones being affected by ongoing opioid use. There are others.

According to Zamanipoor Najafabadi, a medical student at the Leiden University Medical Center, “This information can be used to maybe discourage people who are using opioids to get into a euphoric state, because it happens at the expense of their sexual function.” Najafabadi goes on to talk about how it is likely that opioids interfere with hormone levels in men by impacting the hypothalamus. The hypothalamus is the portion of the brain that connects the nervous system to the pituitary gland.

The Netherlands study was no small feat. The research included the cumulative findings of 15 different studies. The study included 3,250 men, all of whom had been using opioids to excess. According to the study, 65 percent of the men had chronically low testosterone levels.

Dr. Ronald Tamler, a professor of endocrinology at the Icahn School of Medicine at Mount Sinai in New York City, said the study “Is an excellent reminder that chronic opioid use affects multiple hormonal axes, especially the gonadal axis. Some men treated with opiates can revive their own testosterone production by altering their pain regimen. This should always be done in close consultation with a pain specialist.”

Staying in Close Harmony with CDC Guidelines

It seems clear that we have found yet another adverse effect of opioid use—at least of long-term opioid use in men. This research reminds me of the Prescribing Guidelines as published by the Centers for Disease Control and Prevention in 2016. Those documents advise strongly against the use of opioids in the long-term. We can add the Netherlands study to the growing stack of similar studies—all of which paint opioids in a harmful light.

We need to reduce our use of opioids significantly. Even if it were not for the addictive factor of these drugs—which is the big risk factor—there’s also the significant array of adverse side effects that are part and parcel of pharmaceutical opioid consumption.

According to the Centers for Disease Control and Prevention:

“Before starting opioid therapy for chronic pain, clinicians should establish treatment goals with all patients, including realistic goals for pain and function, and should consider how opioid therapy will be discontinued if benefits do not outweigh risks. Clinicians should continue opioid therapy only if there is clinically meaningful improvement in pain and function that outweighs risks to patient safety.”

That was only one of about a dozen different guidelines from the CDC, all of which caution patients and doctors alike from not only the use of opioid analgesics but also from the ongoing use of such analgesics. That is the keynote that is often forgotten or overlooked. It’s not always about whether or not to use opioid pain relievers. Sometimes it’s about how long they are being used for.

“… clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three days or less will often be sufficient; more than seven days will rarely be needed.”

In closing, the CDC says:

“Long-term opioid use (which is to be avoided) often begins with treatment of acute pain. When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three days or less will often be sufficient; more than seven days will rarely be needed.”

So we are talking about mere days of use of opioid pain relievers. If we could reduce the majority of current prescribing that is occurring at this time to nothing and if we could also reduce the duration of whatever prescribing remains, we’d be well on our way to not only reducing addiction but also towards reducing the adverse side-effects of opioid use such as hormone loss.

We know there are alternative medicines and routes to pain relief that can be quite helpful to us. And they don’t carry the kind of risks and dangers that opioid pharmaceuticals do. It’s time we started supporting these routes over the pharmaceutical route. It would seem that our very futures depend on it.

Sources:

• https://www.usnews.com/news/opioid-overuse-can-lower-hormones-to-harmful-levels
• https://www.cdc.gov/drugoverdose/pdf/Guidelines_Factsheet-a.pdf

Reviewed and Edited by Caire Pinellli, iCAADC, CCS, LADC, RAS, MCAP