Despite being the standard of analgesia therapy, opiates do have adverse clinical effects which can limit their use. Most of the side effects of opioids are dose-dependent and these effects are often magnified when used with other sedatives or substances of abuse. These side effects can cause patients to discontinue opiate therapy. Opioids cause a decrease in central nervous system function marked by sedation. Currently, however, there are no limitations on driving while taking opiates (Tollison et al. 2002). It should be noted that there is a great effort in the pharmaceutical industry to develop mu1 selective agonist agents with all of the positive features of opiates but without the many side effects.
Perhaps the most important effect of opiates is respiratory depression, which can ultimately lead to apnea. Care must be taken in the treatment of an obese patient with opiates as this group is more likely to experience respiratory complications. Special consideration must be given for the use of opiates during obstetrical analgesia, as the fetus is more susceptible to the respiratory-depressant effects of opiates than the mother (Hardman and Limbird 2009).
Opiates can cause nausea, vomiting, and as described earlier decreased gastric motility, potentially leading to constipation. Tolerance to the constipating effects of opioids does not develop. Opiates can also cause significant clinically relevant urinary retention. Recently data, including work by Dr. Johnathan Moss at the University of Chicago, suggest that opiates are associated with immunosuppression and can increase the rate of growth of infection as well as neoplastic cells, a feature not seen in patients who are without infection or cancer states. However, prolonged exposure to opioids appears much more likely to suppress immune function than do short-term exposure to these drugs (Ballantyne et al. 2009).
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