title: Safety concerns with long-term opioid use.
abstract: BACKGROUND
  The benefits of opioid therapy must be balanced by any adverse effects. In recent years, prescription opioids have been increasingly prescribed, but have also been associated with increased abuse, overdose and death.
  
  
  METHODS
  This review will categorize the common risks of opioid administration. Recognized adverse effects of opioid therapy include constipation, tolerance, endocrinopathies, sleep disorders, cognitive effects, respiratory depression, overdose and addiction. Studies have shown that there is increased risk of overdose and death with higher daily opioid doses, particularly above a morphine equivalent oral daily dose of 100 milligrams. Extended-release/long acting (ER/LA) opioid formulations may be beneficial for the compliant patient, yet may expose a higher risk for abuse if used inappropriately since each tablet carries a larger dose of medication.
  
  
  CONCLUSIONS
  Prospective, controlled one-year trials are needed to establish the efficacy and safety profile of chronic opioid therapy. In addition to the well known side effects of chronic opioid therapy, the influence and serious effect of opioids on sleep and central sleep apnea is only recently being investigated. The lowest possible daily opioid must be used to manage chronic pain, and all clinicians should be cautious in the use of daily morphine equivalent doses above 50-100 milligrams.
authors.affiliation: a Department of Anesthesiology , University of Kentucky Medical Center , Lexington , KY , USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Harned
authors.affiliation: a Department of Anesthesiology , University of Kentucky Medical Center , Lexington , KY , USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Sloan
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D059350:Chronic Pain / Q000188:drug therapy*; D003692:Delayed-Action Preparations; D004305:Dose-Response Relationship, Drug; D062787:Drug Overdose; D004361:Drug Tolerance; D006801:Humans; D009293:Opioid-Related Disorders / Q000150:complications / Q000453:epidemiology*; D013997:Time Factors
chemical_list: D000701:Analgesics, Opioid; D003692:Delayed-Action Preparations
keywords: Chronic pain; abuse deterrence; extended-release; naloxone; naltrexone; opioids