Opioids are a class of very strong pain medicine.  This sheet explains the risks of using opioids to treat pain for long periods of time.  Ask your doctor if you have questions after reading this sheet. 

Important Points

  • Opioids provide good pain relief.  In low doses, they are usually safe.  In high doses, these drugs have dangerous side effects and complications.
  • High doses of opioids are NOT good for chronic non-cancer pain.
  • Increasing a dose of opioids does not always help pain, BUT it does increase side effects.
  • When misused, pain medications are as dangerous as illegal drugs.

Accidental Overdose and Death

Prescription medications are only safe if taken as directed.  Taking too much opioid medication can result in overdose and death.  Combining opioids with alcohol, sleep aids or muscle relaxers increases the risk of overdose and death.  Tell your doctor about all the medications you take so you don’t have an unwanted interaction.  Do not drink alcohol or use illegal drugs while taking opioid medication. 

Breathing and Heart Problems

Opioids cause breathing to be slower and more shallow than normal.  Taking too much opioid medication can stop breathing all together and can cause death.  Mixing opioids with alcohol or other drugs increases the risk of breathing problems.  In some patients, opioids can cause irregular heart rhythms.  Irregular heart rhythms are very serious and can be life threatening. 


Opioid medications cause drowsiness.  This increases the risk of falls, accidents and injury.  Do not drive, operate heavy machinery or make serious health or financial decisions until you know how the medication affects you.

Physical Dependence

Prolonged or overuse of drugs prescribed for pain or sedation may lead to addiction or dependence. Physical dependence leads to drug withdrawal symptoms if you stop taking the drug. With psychological dependence you feel a strong craving for the drug. You may be unable to stop using the drug even though you want to stop. These problems can occur even when the medication is taken at the prescribed dose.


Over time, many people must increase their dose of opioid pain medicine to get the same amount of relief. This is called tolerance. Tolerance is common with long-term use of opioid pain medicine as pain receptors become less sensitive to the medicine over time. At some point, increasing the dose of medication will not improve pain relief at all. Increased doses lead to increased risk of side effects and complications. 

Sleep Disorders

Sleep apnea is a condition where there are long pauses between breaths when you sleep. This leads to low oxygen levels which can damage your heart and lungs. Using opioid medication increases the risk of sleep apnea. In some patients, opioids disrupt sleep patterns and contribute to poor sleep. 

Constipation and Bowel Dysfunction

Opioids medications are known to cause constipation. Even with treatment strategies bowel issues are a major challenge. Traditional laxatives may not be enough to eliminate constipation. Other medications may be necessary. If medicine taken by mouth is not effective, rectal interventions may be needed. Rectal interventions include:

  • Suppositories
  • Enemas
  • Rectal irrigation
  • Manual evacuation

Low Sex Hormones

Opioid medications lower hormone levels. In men, opioid use may increase erectile dysfunction and decrease sex drive. In women, opioid use may stop your period. This is especially true for opioids delivered by a patch. 

Opioid Induced Hyperalgesia

Opioid induced hyperalgesia is a condition where opioid pain medications create more pain rather than pain relief. In this case, increasing doses of pain medication can increase pain. 

Increase Risk of Fracture

Opioids affect bone health. Patients who take opioids for a long time can develop osteoporosis (weak bones). This leads to an increased risk of bone fractures. 

Dry Mouth and Tooth Decay

Opioids can make your mouth dry. Chronic dry mouth leads to acid erosion of tooth enamel. It is very important to take good care of your teeth while taking opioids. Visit your dentist to monitor the health of your teeth. Also consider a saliva substitute.