Dear Alice,

A couple of questions for you: what are the long-term side effects of one abusing prescription painkillers, such as Vicodin? What advice can you give to someone who has gotten off of them to help them stay off???

Thanks!

Dear Reader,

These are great questions! Opioid analgesics (a.k.a. prescription painkillers) are a family of substances that act on the central nervous system (CNS) to change the way the brain perceives and responds to painful stimuli. When these painkillers are used in a different way than they were prescribed (i.e., taking more at a time than indicated or for longer than originally prescribed) or for long term use (more than one to two weeks), the user may experience both physiological and psychological side effects, including severe withdrawal symptoms (such as anxiety, nausea, vomiting, or abdominal pain) if they try to discontinue using suddenly. Because these effects can be quite serious or even life-threatening, it's recommended that detox from these substances be completed under the supervision of a health care provider. Unfortunately, even after someone has successfully stopped using prescription painkillers, they may continue to feel long-term effects, such as an increased sensitivity to pain, greater vulnerability to stress, and a decreased ability to feel pleasure (more on this later). But, the good news is that once someone has safely stopped using prescription painkillers, there are many resources they can turn to that can help them stay off. Recovery from substance misuse can be a difficult journey, but there are many different support options to choose from, including individual and group-based strategies. 

Opioid analgesics are often prescribed to temporarily manage pain after surgery or an injury. Reader, you mentioned Vicodin specifically, which contains both an opioid (hydrocodone) and acetaminophen (a pain reliever and fever reducer). Because a side effect of these medications is temporary euphoria, or a “high” that produces short-term feelings of happiness and well-being, these substances can be habit-forming, and have a high potential for misuse and dependence. The risk for dependence increases as duration, frequency, and dosage increase. Some people who become addicted to prescription painkillers may even turn to illegal options like using illicit drugs (such as heroin) or buying opioids illegally when their prescription is unobtainable or when the volume and frequency of their use requires a more affordable alternative.

Now, when it comes to long-term effects of opioid use, the many possibilities may include dry mouth, itching, nausea, drowsiness, weight gain, sleep disturbance, hormonal imbalances (such as reduced libido, erectile dysfunction, fatigue, depression, testicular atrophy, irregular/absent menstrual periods, and infertility), anhedonia (the reduced capacity to feel pleasure), immunological suppression, hallucinations, severe confusion, constipation, dizziness, and lightheadedness, withdrawal, and dependence. These effects can vary between individuals, and might depend on a number of factors, including:

  • Metabolism: People who can metabolize prescription opioids more quickly may experience fewer side effects or may experience them to a lesser degree than people whose bodies take longer to break down and eliminate the substance.
  • Mixing: When opioids are taken in combination with other CNS depressants (such as alcohol, benzodiazepinescodeine, or cough medicine), the effects may include breathing difficulty, increased dizziness, sleepiness, unresponsiveness, and even death. Opioids can also interact with psychoactive substances like marijuana and anti-depressant medications. Combining opioids with acetaminophen can lead to liver damage, especially in the case of Vicodin, which already contains that drug.
  • Tolerance: People who have developed a tolerance may not feel the same level of side effects as non-tolerant users. Tolerance can lead folks to use in greater doses or higher frequencies. Because an additional side effect of long-term use is hyperalgesia (excessive sensitivity to pain), people who develop a tolerance might need even higher doses to manage pain, which can increase the risk of addiction or overdose.

Additionally, individuals who already have existing conditions such as sleep disorders (including sleep apnea), pulmonary conditions, or liver or kidney impairment, may be more likely to experience the more serious side effects like respiratory depression (a.k.a. hypoventilation — when someone’s breaths per minute slows), which can lead to death. Also, mothers who are pregnant or nursing can pass opioids to their child through the placenta or breast milk, which can lead to them developing opioid dependence, too.  

The good news is that there are treatment options available, such as methadone treatment (link is external) and cognitive behavioral therapy, to help people safely taper their use of prescription painkillers and maintain abstinence. It may help to keep in mind that substance misuse affects people of all socioeconomic classes, races, genders, ages and backgrounds — which means that recovery can present unique challenges to different individuals. For example, for folks who have to manage chronic pain, working closely with their health care provider to develop effective, alternative treatment options may be critical to maintaining their recovery goals. This may also require additional attention when surgery or anesthesia is needed. Another unique challenge to consider is that those in recovery who also have anhedonia may experience an increased susceptibility to stress, decreased response to positive stimuli (such as tasty food or enjoyable sex), and may be more sensitive to triggers such as being around the substance or seeing someone else use the substance (even if it’s in a movie, for instance). However, talking with a health care provider or mental health professional may help folks in recovery address their individualized needs.

Another element that can really impact a person in recovery is their support system. About half of those who misuse prescription pain killers often obtain them from a friend or relative rather than from a medical professional. So, having a strong support system and a safe environment that is sensitive and respectful of the needs of a person in recovery is essential to helping them abstain from using. Reaching out to family and friends for motivation and support can help people in recovery maintain their goals and overcome new or existing challenges as they move forward. You might be interested in checking out Daughter's in AA — What are our responsibilities as her family? in the Go Ask Alice! archives for more information. 

Finally, regularly meeting with a mental health professional or reaching out to support organizations can also help folks in recovery manage their stress levels and develop strong coping strategies. It might also be helpful to research community resources for recovery programs that may provide support in the form of group therapy or paired mentoring. For example, Narcotics Anonymous has many established branches in several states, or the Substance Abuse and Mental Health Service Administration (SAHMSA) may help locate a nearby treatment program.

Alice!

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