5 ms·

What are the cognitive side effects of opioids. I’ve always thought they weren’t very neurotoxic.

etrevino 8y ago
They're not, but they can cause depression and/or anxiety. Also, euphoria, agitation, et. al. In one person I noticed that she had developed terrible memory problems. She used to be an academic, but there's no way she could function in an academic environment now. The most pernicious side effects-- in my opinion-- that have fairly scary mental health ramifications are hyperalgesia [1] and uncontrollable itching [2]. I saw a girl afflicted by hyperalgesia and the itching and it was terrible. The solution was to take her off of the morphine, but she wouldn't consider it. Paradoxically, she resorted to self harm to control the issue. Unfortunately, I don't know how the story ended. The last I heard a dermatologist was talking about THC creams being investigated for this type of thing. But I have no knowledge of that. I only mention it because it sounds intriguing. Note: I'm not a doctor. I work in the US government and my job gives me a lot of experience working with pain management doctors and their patients. [1] https://www.ncbi.nlm.nih.gov/pubmed/21412369 https://www.ncbi.nlm.nih.gov/pubmed/21412369 [2] https://www.jpsmjournal.com/article/S0885-3924(98)00115-8/fulltext https://www.jpsmjournal.com/article/S0885-3924(98)00115-8/fu...
- candiodari 8y ago
  > I saw a girl afflicted by hyperalgesia and the itching and it was terrible. The solution was to take her off of the morphine, but she wouldn't consider it. Paradoxically, she resorted to self harm to control the issue. You know, why did she take morphine in the first place. That's the big missing link here. People's actions make sense. If, for instance, she had a hernia and couldn't treat it (too expensive, even with insurance, or just no insurance), that would explain her behavior. Same with any other painful or degenerative condition, and in fact quite a lot of untreated conditions. More generally that is the problem there. Addiction, yes, but in the sense of psychological addiction, not substance abuse. If you're in chronic pain you've either got the willpower of an olympic athlete or you're "addicted".
  - etrevino 8y ago
    She had a degenerative genetic condition. Her pain was exceptional. It was very sad, because there was no expectation of it improving.
    - candiodari 8y ago
      Then she is not a substance abuser, and cannot be helped with less addictive pain medication. She will be addicted to pain medication, and probably not really care which one, beyond effectiveness arguments. She is not addicted to morphine (or if she self-medicates, cocaine or ...). She cannot deal with the amount of pain she's subjected to without such substances. These are not drug addicts, even if they are substance addicted that's a secondary problem at best. There are many people like this (with much pain, not so much with degenerative genetic conditions). And I would argue this medication will actually help them, because if you've ever had morphine (I don't wish kidney stones on anyone, but that's why I've had morphine, and probably a lot, I don't remember particularly well), you know that it puts this "cloud" over your mental state. Something that helps with the pain but leaves you fully conscious, unlike morphine, would be welcome.
      - etrevino 8y ago
        Oh yeah, I 100% agree.

They're not, but they can cause depression and/or anxiety. Also, euphoria, agitation, et. al. In one person I noticed that she had developed terrible memory problems. She used to be an academic, but there's no way she could function in an academic environment now. The most pernicious side effects-- in my opinion-- that have fairly scary mental health ramifications are hyperalgesia [1] and uncontrollable itching [2]. I saw a girl afflicted by hyperalgesia and the itching and it was terrible. The solution was to take her off of the morphine, but she wouldn't consider it. Paradoxically, she resorted to self harm to control the issue. Unfortunately, I don't know how the story ended. The last I heard a dermatologist was talking about THC creams being investigated for this type of thing. But I have no knowledge of that. I only mention it because it sounds intriguing. Note: I'm not a doctor. I work in the US government and my job gives me a lot of experience working with pain management doctors and their patients. [1] https://www.ncbi.nlm.nih.gov/pubmed/21412369 https://www.ncbi.nlm.nih.gov/pubmed/21412369 [2] https://www.jpsmjournal.com/article/S0885-3924(98)00115-8/fulltext https://www.jpsmjournal.com/article/S0885-3924(98)00115-8/fu...

candiodari 8y ago
> I saw a girl afflicted by hyperalgesia and the itching and it was terrible. The solution was to take her off of the morphine, but she wouldn't consider it. Paradoxically, she resorted to self harm to control the issue. You know, why did she take morphine in the first place. That's the big missing link here. People's actions make sense. If, for instance, she had a hernia and couldn't treat it (too expensive, even with insurance, or just no insurance), that would explain her behavior. Same with any other painful or degenerative condition, and in fact quite a lot of untreated conditions. More generally that is the problem there. Addiction, yes, but in the sense of psychological addiction, not substance abuse. If you're in chronic pain you've either got the willpower of an olympic athlete or you're "addicted".
- etrevino 8y ago
  She had a degenerative genetic condition. Her pain was exceptional. It was very sad, because there was no expectation of it improving.
  - candiodari 8y ago
    Then she is not a substance abuser, and cannot be helped with less addictive pain medication. She will be addicted to pain medication, and probably not really care which one, beyond effectiveness arguments. She is not addicted to morphine (or if she self-medicates, cocaine or ...). She cannot deal with the amount of pain she's subjected to without such substances. These are not drug addicts, even if they are substance addicted that's a secondary problem at best. There are many people like this (with much pain, not so much with degenerative genetic conditions). And I would argue this medication will actually help them, because if you've ever had morphine (I don't wish kidney stones on anyone, but that's why I've had morphine, and probably a lot, I don't remember particularly well), you know that it puts this "cloud" over your mental state. Something that helps with the pain but leaves you fully conscious, unlike morphine, would be welcome.
    - etrevino 8y ago
      Oh yeah, I 100% agree.