Does intermittent opioid abuse have a long-term negative effect on health?

Question

If somebody were to take 20mg of an opioid (for example, hydrocodone) twice a week every week, would there be any negative long-term effects?

Answer 1

Low dosages of opioids is unlikely to have long-term negative health effects when taken responsibly and prescribes by a doctor. If the drug is abused however, dependence may occur and abuse is associated with irresponsible usage which can be very dangerous. Dependence usually results in usages of higher dosages, which have long term negative side-effects.

Prevalence of side effects of prolonged low or moderate dose opioid therapy with concomitant benzodiazepine and/or antidepressant therapy in chronic non-cancer pain.

Moderate or low dose opioid therapy in conjunction with or without benzodiazepines, antidepressants, or in combinations are associated with minor side effects

"Low dose" usually means 100mg of morphine which equals 17mg of hydrocodone/day (At this actual "low dose" I believe the results do get much more disputable. At this dosage, higher death rates are observable in most large studies)

Opioids in the management of chronic non-cancer pain: an update of American Society of the Interventional Pain Physicians' (ASIPP) Guidelines.

best action may differ depending on circumstances or patients' or societal values.

(According to Duffy's Rehab)

"If you’re taking Vicodin for the right reasons and in the right way, then your chances of being addicted to Vicodin (or any other prescription medication) are extremely low—less than 10%.

The risk of addiction is often influenced by other factors, such as

Genetics
Family history
Environmental factors
Past history of drug abuse

However, if an individual is taking Vicodin non-medically or is deliberately misusing it, the chances of addiction are significantly higher.

The dosage doesn't matter. The reason is that drug dependence also depends on psychological dependence. Breaking the habit of use is the hardest for most users. For example, nicotine is removes from the body in three days, but smokers struggle with psychological addiction for months or even years. According to Wikipedia:

"They are similar in that addiction is a physiological "craving" for something and psychological dependence is a "need" for a particular substance because it causes enjoyable mental affects. A person becomes dependent on something to help alleviate specific emotions.

Drugs abuse and sometimes therapy with a counselor is needed treat the underlying reasons someone might be trying to alleviate emotions with a drug. The biggest harm to your long-term health from drug abuse is mental and emotional. It will harm relationships and emotional and spiritual fulfillment.

Now, there is also some evidence that this dosage does not cause tolerance/physical dependence , even in long-term (9 years), recreational users of Vicodine (1-2 times per week), atleast according to this study.

There was little information on the direct acute effects of oxycodone and hydrocodone in this population, and therefore, a pilot study was completed to help guide the choice of safe, tolerable, and equipotent doses of oxycodone, hydrocodone and hydromorphone for use in the current study. In all respects, the pilot data collected were identical in nature and scope to that collected in the present study except: 1) doses were administered in ascending order for safety purposes, and 2) there were a greater number of test conditions (17 total, five doses each of oxycodone, hydrocodone and hydromorphone, placebo and an active practice condition) and a wider range of test doses (oxycodone [5 mg – 50 mg], hydrocodone [7.5 mg – 60 mg], and hydromorphone [2.5 mg – 35 mg]. Results showed that oxycodone (5 mg) and hydromorphone (2 and 5 mg) were inactive in sporadic opioid users.

In other words, small therapeutic dosages were still effective for Vicodin abusers. The reason appears that these users were mostly women and elderly who did not use strong street drugs or crush or snort the medication, as opposed to the other groups of users. (For abusers of opiods, this may serve as a huge warning however, that dependence is likely to result in switching or mixing their usage with a different opioid or mixing with other drugs-Zanax, Heroin,ect- to get a "better high," placing them into the high-risk "oxycodone" group)

Hydrocodone abuse and dependence is an enormous public health issue, which suggests that many, many people are not so resistant to dependence and for those people it most certainly tragic. Abusing opioids is like playing Russian Roulette. 27,000 people became dependent on Vicodin in 2009, based on the figures who either required treatment from a doctor or ended up in the emergency room due to abuse or overdose.

Here is a presentation by WHO on its guidelines for pain management.

If taking meds 10 days or longer on regular bases withdrawal symptoms may occur, wean off meds slowly. Withdrawal results in hypertension, nausea, vomiting, body aches, diarrhea, anxiety, tremors, tachycardia, diaphoresis, abdominal pain

If you are abusing a medication, it would always be possible to be unable to access the drug. Also if the user has a legitimate need, especially if the user fails to recognize their drug use is a problem, they may have difficulty obtaining pain management.

If dependence becomes problem and large dosages start being used:

adverse consequences including hormonal and immune system effects

Therapeutic opioids: a ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids. http://www.ncbi.nlm.nih.gov/pubmed/18443641

Vicodin can also of course cause death and liver damage if you take too much and mix it with alcohol and other drugs. It can increase your risk of a car accident or injury, too, no matter who you are or why you are taking it. Like almost all medications, Vicodin has rare severe side effects, such as death, and should not be taken by people with certain health condition. It should always be prescribed by doctor to ensure benefits outweigh the risks.