Learning Objectives

By the end of this topic, the student should be able to:

  • Discuss the effects of religiosity and spirituality on opioid use.
  • Describe emotional responses to opioid use.
  • Describe the mental and psychological effects of opioid use.
  • Describe the immediate and long-term physical effects of opioid use.

Key Concepts

  • Preliminary data from a US study suggests an inverse relationship between religiosity or spirituality and substance use disorders.
  • Focus group discussions found that spirituality and religious practices were influenced in complex ways during active opioid use disorder but were helpful during recovery.
  • Qualitative studies on the experiences of opioid use report both positive and negative effects of drug use; however, the positive effects tend to outweigh the negative impact. Negative emotions related to opioid use were largely associated with sociocultural aspects as opposed to the physiological effects of opioids.
  • A study in the United States found that adults with mental health disorders (mood and anxiety disorders) were more likely to use opioids and remain on opioid therapy long term.
  • Adults with mental health conditions received 51 percent of all opioid prescriptions in the United States even though they compose only 16 percent of the total population.
  • A higher daily dose of prescribed opioids is associated with higher risk of overdose and significant health problems, such as fractures, opioid addiction, intestinal blockages, and sedation.

Spiritual Effects of Opioids

Preliminary data suggests an inverse relationship between religiosity or spirituality and substance use disorders in the United States. This relationship was not mediated by social support or mental health status, which might suggest an independent association between the two factors (Edlund et. al., 2010).

  • Higher spiritual well-being is also shown to reduce relapse during opioid use disorder and might provide better recovery outcomes and improved mental health status.
  • Chronic pain can diminish spiritual well-being, and individuals reported that feeling drowsy on opioids resulted in withdrawal from spiritual obligations. This might create a negative downward cycle in which diminished spiritual well-being increases feelings of chronic pain and dependence on opioids.
  • On the other hand, those who were able to manage their chronic pain with opioids reported fulfilment of spiritual obligations.
  • A systematic review of the use of psychosocial interventions for treatment of opioid use disorder found that comprehensive treatments accounting for the whole individual and the individual’s beliefs improved treatment outcomes (Dugosh et. al., 2016).
  • Focus group discussions found that spirituality and religious practices were influenced in complex ways during active opioid use disorder but were helpful during recovery (Heinz et. al., 2010).

Based on the information above, it is important to discuss as early as possible how treatment affects a person’s religious or spiritual obligations. The goal is to ensure that individuals using opioids are aware of the potential effects of opioid use on spiritual well-being.

Emotional Responses to Opioid Use

Qualitative studies on the experiences of opioid use report both positive and negative effects of drug use; however, the positive effects tend to outweigh the negative impact (Brooks, Unruh, & Lynch, 2015).

NOTE: Negative emotions related to opioid use were largely associated with sociocultural aspects as opposed to the physiological effects of opioids.

A qualitative study interviewing 21 African-American adults with sickle-cell disease who used prescribed opioids described their experience as follows (Alsalman, Wong, Posner, & Smith, 2013):

  • negative feelings
    • feelings of guilt
    • feelings of isolation
    • dependency on others
    • feelings of decreased cognitive ability
    • fear of consequences
    • resentment towards health and social service providers
  • positive feelings
    • feeling independent from a pain-centric lifestyle
    • avoidance of pity or sympathy
  • Pain management using opioids had both positive and negative effects on
    • relationships
    • moods
    • activities of daily living, functioning
    • productivity at workplace/school
    • fulfilment of social or spiritual obligations
    • overall world view

A qualitative study in Canada showed that nine participants between the ages of 40 and 68 years found it challenging to balance the negative effects of opioids with pain relief and improved daily function (Brooks, Unruh, & Lynch, 2015). Participants felt:

  • hesitant to start opioid therapy for chronic pain management
  • as though they had regained previously lost quality of life
  • fatigue, sluggishness, and sometimes reduced motivation to do things
  • stigmatized by media portrayals of opioid users
  • like a “junkie” to health and social service professionals
  • guilty about opioid use
  • fear of becoming addicted and fear of getting robbed
  • isolated as though they were keeping a secret
  • thankful for the pain relief provided by opioids

Mental and Psychological Effects of Opioid Use

Adults with mental health conditions received 51 percent of all opioid prescriptions in the United States even though they compose only 16 percent of the total population (Davis, Lin, Liu, & Sites, 2017).

Three mutually exclusive hypotheses exist on the relationship between non-medical prescription opioid use (NMPOU) and mood and anxiety disorders:

  1. Precipitation hypothesis: NMPOU can lead to developing mood/anxiety disorders.
  2. Self-medication hypothesis: those with mood/anxiety disorders are more likely to “self-medicate” with NMPOU.
  3. Shared vulnerability hypothesis: each factor increases vulnerability to the other.

A study in the United States found that adults with mental health disorders (mood and anxiety disorders) were more likely to use opioids and remain on opioid therapy long term (Davis, Lin, Liu, & Sites, 2017).

  • Longer duration of opioid use (more than 30 days) might also increase the risk of developing depression.
  • Lifetime non-medical prescription opioid use was associated with the incidence of major depressive disorder, bipolar disorder, and anxiety disorders (including generalized anxiety disorder) (Martins et. al., 2012).

The evidence shows that improving pain management is especially critical in those who also present with mental health disorders, including mood and anxiety disorders.

Short-term and Long-term Physical Effects of Opioids

A higher daily dose of prescribed opioids is associated with a higher risk of overdose and significant health problems, such as fractures, opioid addiction, intestinal blockages, and sedation.

Short-term physical effects reported by individuals using opioids include

  • nausea
  • vomiting
  • itching
  • constipation
  • drowsiness
  • mood changes
  • sweating,
  • changes in sexual functioning such as erectile dysfunction in men

Long-term opioid use has adverse physical effects on

  • the respiratory system (sleep-disordered breathing such as sleep apnea, and hypoxemia, pneumonia, and respiratory system depression)
  • the gastrointestinal system (constipation, bowel obstruction)
  • the musculoskeletal system (increased risk of falls and fractures especially for older adults)
  • the cardiovascular system (hypotension, bradycardia, myocardial infarction, heart failure)
  • the immune system (immunosuppressive effects)
  • the endocrine system (sexual dysfunction, infertility, fatigue, metabolic syndrome, insulin resistance)
  • the central nervous system (dizziness, sedation, clinical depression)

It has been suggested that long-term opioid treatment is associated with an 87 percent increase in all-cause mortality (Baldini, Von Korff, & Lin, 2012).

Stop and Think

Now that you have reviewed this content, consider the following:

How might pain be experienced differently in those with comorbid mental health issues?

Consider both the pain management aspects and other feelings associated with the sociocultural aspects of opioid use.

Questions

True or false: On average, persons using opioids reported that positive effects generally outweighed the negative effects.

How many different physiological systems can long-term opioid use impact?

References

Alsalman, A., Wong, J. L., Posner, B., & Smith, W. (2013). Impact of prescribed opioids on biopsychosocial-spiritual function in patients with sickle cell disease: A multi-phase, mixed methods study. The Journal of Pain, 14(4), S76.

Baldini, A., Von Korff, M., & Lin, E. H. (2012). A review of potential adverse effects of long-term opioid therapy: A practitioner’s guide. The primary care companion to CNS disorders, 14(3).

Brooks, E. A., Unruh, A., & Lynch, M. E. (2015). Exploring the lived experience of adults using prescription opioids to manage chronic noncancer pain. Pain Research and Management, 20(1), 15–22.

Davis, M. A., Lin, L. A., Liu, H., & Sites, B. D. (2017). Prescription opioid use among adults with mental health disorders in the United States. The Journal of the American Board of Family Medicine, 30(4), 407–417.

Dugosh, K., Abraham, A., Seymour, B., McLoyd, K., Chalk, M., & Festinger, D. (2016). A systematic review on the use of psychosocial interventions in conjunction with medications for the treatment of opioid addiction. Journal of addiction medicine, 10(2), 91.

Edlund, M. J., Harris, K. M., Koenig, H. G., Han, X., Sullivan, G., Mattox, R., & Tang, L. (2010). Religiosity and decreased risk of substance use disorders: is the effect mediated by social support or mental health status? Social Psychiatry and Psychiatric Epidemiology, 45(8), 827–836.

Gomes, T., Mamdani, M. M., Dhalla, I. A., Paterson, J. M., & Juurlink, D. N. (2011). Opioid dose and drug-related mortality in patients with nonmalignant pain. Archives of Internal Medicine, 171(7), 686–691.

Heinz, A. J., Disney, E. R., Epstein, D. H., Glezen, L. A., Clark, P. I., & Preston, K. L. (2010). A focus-group study on spirituality and substance-user treatment. Substance Use & Misuse, 45(1–2), 134–153.

Martins, S. S., Fenton, M. C., Keyes, K. M., Blanco, C., Zhu, H., & Storr, C. L. (2012). Mood and anxiety disorders and their association with non-medical prescription opioid use and prescription opioid-use disorder: Longitudinal evidence from the National Epidemiologic Study on Alcohol and Related Conditions. Psychological Medicine, 42(6), 1261–1272.

Noormohammadi, M. R., Nikfarjam, M., Deris, F., & Parvin, N. (2017). Spiritual well-being and associated factors with relapse in opioid addicts. Journal of Clinical and Diagnostic Research: JCDR, 11(3), VC07.

Scherrer, J. F., Salas, J., Copeland, L. A., Stock, E. M., Ahmedani, B. K., Sullivan, M. D., Burroughs, T., Schneider, F. D., Bucholz, K. K., & Lustman, P. J. (2016). Prescription opioid duration, dose, and increased risk of depression in 3 large patient populations. The Annals of Family Medicine, 14(1), 54–62.

Shaygan, M., & Shayegan, L. (2019). Understanding the relationship between spiritual well-being and depression in chronic pain patients: The mediating role of pain catastrophizing. Pain Management Nursing, 20(4), 358–364.