Complications and Comorbidities of Opioid Use Disorder

Opioid use disorder (OUD) is a serious condition that can lead to life-threatening complications. Complications are health problems that can occur with a specific medical condition. OUD is also often linked to other health conditions called comorbidities.¹

OUD results from an inability to control one’s use of opioids. Opioids include:¹

• Prescription pain medicines like oxycodone and hydrocodone
• Synthetic drugs like fentanyl
• Illegal drugs like heroin

Understanding the health effects of opioid misuse is important for anyone living with OUD or caring for someone who has it.¹

Complications of opioid use disorder

OUD is a complex condition that can have serious complications. OUD complications may include:^1-3

• Overdose
• Infections and infectious disease risks
• Problems during pregnancy
• Death

Overdose

One of the most serious complications of OUD is an overdose. Opioids slow down breathing and heart rate. Taking too much can cause breathing to stop. This can lead to loss of consciousness, brain damage, or death.^1-3

Overdose is a medical emergency. If you think someone has overdosed, call emergency services immediately. Signs of an overdose include:^1-3

• Slow or shallow breathing
• Blue lips or fingernails
• Being unresponsive or unconscious
• Pinpoint (very small) pupils

Naloxone is a medicine that can reverse an opioid overdose if given quickly. Having access to naloxone and knowing how to use it can save lives. Many states make it accessible without a prescription and at little or no cost. Find out your state’s access rules when it comes to naloxone.^1-3

Infections and other health risks

Sharing needles or using non-sterile equipment to inject opioids can cause infections. These include skin infections, abscesses, and more serious conditions like infection of the heart lining (endocarditis).^2,3

OUD is also linked to a higher risk for hepatitis C and HIV. These diseases spread through contact with infected blood. Contact may occur through shared needles and other risky behaviors linked to drug use.^3,4

Problems during pregnancy

Misusing opioids during pregnancy can cause serious complications for both the parent and the baby. Opioid use increases the risk of:^1,3

• Miscarriage
• Premature birth
• Stillbirth

Babies exposed to opioids in the womb may develop neonatal abstinence syndrome (NAS). NAS causes withdrawal symptoms in newborns like irritability, poor feeding, and tremors. People with OUD who are pregnant should seek specialized care to reduce these risks.^1,3

Death

Having OUD increases a person’s risk of dying. Death may occur from an overdose, but other factors can contribute as well. Long-term opioid use can weaken the immune system, increasing the risk of infections. It can also lead to poor decision-making, which may result in accidents, risky behaviors, or ignoring health conditions.^1-3

Comorbidities of opioid use disorder

Comorbidities are other health conditions that often occur alongside OUD. These include:^4,5

• Mental health disorders
• Chronic pain
• Cancer
• Infectious diseases like HIV and hepatitis C

Mental health disorders

Mental health disorders are common in people with OUD. Research shows that about half of people with a mental health disorder will experience a substance use disorder like OUD at some point in their life. The same is true for those with a substance use disorder – about half develop mental health problems.^2,5

Some people may use opioids to cope with symptoms of depression, anxiety, or post-traumatic stress disorder (PTSD). But over time, opioid use can make mental health problems worse.^4,5

Opioid use can also lead to changes in the brain that affect mood and behavior. People with OUD may feel hopeless or have a hard time finding pleasure in everyday life. This can create a cycle where they use more and more opioids to escape their emotional pain.^4,5

If someone has both OUD and a mental illness, they need treatment for both conditions. This is known as integrated care.⁴

Chronic pain

Many people with OUD begin using opioids to manage chronic pain. Chronic pain is long-lasting pain that may come from conditions like arthritis, injuries, or nerve damage. Opioids can help with pain in the short term. But long-term use can lead to dependence and addiction.⁴

For people with both OUD and chronic pain, finding safer pain management options is important. These options may include physical therapy, non-opioid medicines, and other treatments.⁴

Cancer

People with cancer sometimes use opioids to manage severe pain caused by the disease or its treatments. While opioids may be necessary for some cancer pain, long-term use can increase the risk of developing OUD.^1,4

Infectious diseases: HIV and hepatitis C

OUD increases the risk of infectious diseases like HIV and hepatitis C. These diseases are often spread when people share needles or other drug equipment. Both HIV and hepatitis C can cause serious damage if left untreated.^2-4

Treatment for OUD can reduce the risk of infectious disease by helping people stop using injectable opioids. Needle exchange programs and access to clean syringes also play a role in prevention.⁶

Why treatment is critical

OUD is a chronic condition, but it is treatable. Treatment can reduce the risk of complications and improve overall health. A comprehensive treatment plan may include:^1-3

• Medicines for opioid use disorder (like methadone or buprenorphine)
• Counseling and behavioral therapies
• Support in managing other health conditions

Seeking help for OUD can save a person’s life. Treatment also helps them address comorbidities like mental health disorders, chronic pain, or infectious diseases. If you or someone you know shows signs of OUD, seek help from a healthcare provider. Support is available, and recovery is possible with the right treatment.^2,4