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Opioids work in the brain and spinal cord by reducing the amount of pain signals sent up into the brain. To do this they must pass into the brain. Any substance that does pass into the brain can cause unwanted or unpleasant effects. Opioids commonly do this, with side effects like nausea, dizziness, drowsiness. These side effects usually improve over days or weeks but occasionally they do not. Other unwanted effects like constipation are also common - this does not improve with time and usually requires another medicine with the opioid to stop it from happening. In the last few years there has been some research suggesting long-term opioid use can cause reduced testosterone in men and reduced oestrogen in women, affecting fertility. This is obviously a concern and research is ongoing.
Opioid drugs need careful attention when starting. Getting to the right dose can take several weeks, and may need to be done gradually. This is also true for stopping opioids which need to be tailed off and not stopped suddenly. This is because the body naturally produces its own supply of opioid chemicals (called endorphins and enkephalins). If these chemicals are added to by opioid drugs from tablets etc, the body drastically reduces how much opioid chemicals it makes. If the tablet supply is suddenly stopped the body then has such little opioid which feels very unpleasant (‘cold turkey’). It can take several days for the body to catch up making the right amount of its own opioid.
There is often concern about getting addicted to strong opioids. Most of this concern is not necessary. In the published research studies there is very little evidence that opioids taken for a pain problem cause addiction. It is easy to become dependent upon opioids in a similar way to someone with asthma may become dependent upon their inhalers.