In this article, I’m going to teach you about a disorder called Opioid-Induced Endocrinopathy which is significantly ruining the physical and mental health of millions of people on opioids. Have you noticed a decline in your libido since you’ve been taking opioids?
I know for myself when I was on opioids I rarely wanted to have sex with my girlfriend at the time. I came to find out years later after quitting opiates that these types of drugs lower testosterone.
But that isn’t even the tip of the iceberg.
It wasn’t until a few years ago that I learned about a disorder called Opioid-Induced Endocrinopathy, which has much more physical and psychological symptoms than just a decrease in libido.
I feel like it will be best if I lead into how I learned about Opioid-Induced Endocrinopathy before I cover the physiology, signs and symptoms, diagnosis, and treatment of the disorder.
But before I do, let me just say this…
If you’re on any type of opiate or opioid drug, you NEED to read this article all the way through.
I know this post is going to be a total eye-opener for countless individuals over the years, and you may be one of them.
Here we go…
Table of Contents
- Clinical Observations While Working at a Methadone Clinic
- Lesson Learned While Blogging
- Opioid-Induced Endocrinopathy – Overview
- Opioid-Induced Endocrinopathy Physiology
- Symptoms of Opioid-Induced Endocrinopathy
- Which Opioids Cause Opioid-Induced Endocrinopathy?
- What is the Treatment Protocol for Opioid-Induced Endocrinopathy?
- Step-By-Step Plan of Action if you Think you have Opioid-Induced Endocrinopathy
- Opioid-Induced Endocrinopathy Success Stories
- A Disturbing True Story
- Opioid-Induced Endocrinopathy – Key Concepts
- Opioid-Induced Endocrinopathy Conclusion
Clinical Observations While Working at a Methadone Clinic
Six years ago, I finished my internship at an Opiate Treatment Program (OTP). Since I did such a great job during my four-month internship, the Clinical Director (CD) told me there was a full-time counseling position open and she would love to hire me for it.
Of course, I was ecstatic!
I had been addicted to RX opiates and then progressed to smoking heroin, then got clean using 40 mg of methadone for seven days and some Valium for a few weeks after discontinuing methadone. Short-term methadone was a miracle for coming off heroin!
It was a dream come true to land my first counseling gig at a treatment facility that was a methadone clinic by day and moonlighted as an Outpatient Program (OP) where people came for all types of substance addictions, and most were prescribed Suboxone by our doctor.
I won’t go into too much detail about my experience working at this facility in this article, but I will write about my clinical observations and patient reporting about a certain “cluster of symptoms” that was very common in methadone patients.
Here were some common symptoms I either noticed and/or was informed about from patients:
- Decreased Libido
- Weight Gain
- Menstrual Irregularities
This is by no means a complete list of the symptoms patients reported after being on methadone for a while. However, these were the most commonly reported to me by methadone patients.
Lesson Learned While Blogging
To make a long story short, I left the counseling profession after a couple of years to start my own company helping opiate addicts, where I would have total freedom of creativity and I could do things my way.
I started a blog called OpiateAddictionSupport.com (which you’re on right now) and in the first few months of blogging, I wrote an article called How To Stop Methadone Weight Gain.
Since there were a lot of people asking this question, I wanted to help out.
My article talked about my clinical observations working at a methadone clinic and how a large percentage of patients reported weight gain, and how the patients that gained the most weight were on about 70-80 mg of methadone and up.
In my article on preventing methadone weight gain, I wrote about the importance of nutrition, hydration, taking certain supplements, and exercise, as I commonly heard from patients that methadone gave them a severe sweet tooth, and hardly anyone said they exercised on methadone.
A few months after I published my article, a reader wrote something in the comment section that totally opened my eyes and made me say “AHA!”
Here is what the guy (named Rowan) wrote:
Great article, but I just wanted to share my own experience which might help others. I have been on methadone for most of the last 20 years and during the last six years my weight increased by 50% and I went from being lean to morbidly obese within three months. My teeth not only rot away but break off if I bite on anything hard.
I tried every imaginable dietary and nutritional weight loss technique including some experimental ones like peptides.
As a teen, I had pet rats and one time I had one of the males neutered by a vet. After the procedure the poor little guy ballooned and got so fat he could barely move. This memory reminded me of my own horrible situation so after years of no success I asked my doctor to check my hormone levels.
As I had suspected my testosterone levels were abnormally low, and I was referred to an endocrinologist – who is also a very famous researcher.
As soon as she found out I was on methadone she told me about Opioid-Induced Endocrinopathy – a condition caused by opioids with a long half-life like methadone which suppresses the performance of the endocrine system and results in the total disruption of sex hormone production.
I had a long series of tests and scans to identify any other possible causes.
What was happening is that the methadone was suppressing the function of the pituitary gland, which is responsible for signaling to the gonads how much testosterone (or estrogen in women) to produce.
The symptoms of low testosterone were exactly those that I had always associated with methadone: profuse sweating, weight gain, facial flushing, tooth decay and breakage, brittle bones.
These are all caused by methadone but indirectly.
In my case, I recently started testosterone replacement therapy and lost 16 kilos in the first month.
I can already see differences in my face and musculature and the fat is gradually being replaced by muscle tissue.
My weight gain ruined my life, shattered my self-confidence and self-esteem and aggravated my depression to the point where I tried to end my life.
Testosterone is giving me hope and finally, I can see a future that isn’t darkened by despair. For far too long methadone patients struggling to stay clean have had to suffer horrible side effects of pharmacotherapy and all this misery is totally unnecessary.” – Rowan
Opioid-Induced Endocrinopathy – Overview
Rowan really helped me out since he shed light on what was really causing methadone weight gain and many other symptoms. Since then, I have updated my article on methadone weight gain to include information on Opioid-Induced Endocrinopathy.
A bit later, I also wrote an article on How To Boost Libido While Taking Suboxone, Methadone, And Other Opiates. And in that article, I also added a section on Opioid-Induced Endocrinopathy.
Now years later, I’m finally writing a complete article specifically about Opioid-Induced Endocrinopathy. You’ve already learned a lot about Opioid-Induced Endocrinopathy from reading Rowan’s story above.
But now I’m going to elaborate on more of the details of this disorder. So let’s begin!
Opioid-Induced Endocrinopathy Physiology
Opioid-Induced Endocrinopathy is one of the most common yet least often diagnosed negative consequences of prolonged opioid therapy. Sustained-action (aka long-acting) opioids used on a daily basis for more than 30 days have a number of negative effects on your endocrine function.
Here are some of the negative effects that the daily use of opioids can have.
Daily use of opioids can decrease levels of:
- Gonadal Sex Hormones
- Growth Hormone
- Dehydroepiandrosterone Sulfate (DHEAS)
To properly teach you about the physiology of Opioid-Induced Endocrinopathy, I’m going to quote a rather large passage from the best article I’ve found on it, called Opioid-Induced Endocrinopathy and published in The Journal of the American Osteopathic Association.
I highly recommend reading that article in its entirety, as it is totally comprehensive and written by two doctors that have done a lot of research and really know this subject well.
Here is a directly quoted passage from that article that explains this disorder:
“The primary mechanism for opiate-induced sex hormone deficiency is suppression of the hypothalamic-pituitary-gonadal axis. Sex hormones are produced by the gonads—testes in men, ovaries in women. The principal sex hormones are testosterone in men and estradiol in women.
The luteinizing hormone (LH) and follicle-stimulating hormone (FSH) are referred to as gonadotropins because they stimulate production of gonadal hormones.
The hypothalamic-pituitary-gonadal process of controlling the production and secretion of sex hormones begins with secretion of gonadotropin-releasing hormone (GnRH) by the hypothalamus (Figure 2). This hormone stimulates the pituitary gland to secrete LH and FSH.
Once released into systemic circulation, these two hormones interact with the testes or ovaries to secrete testosterone or estrogen, respectively.
As sex hormone levels rise, they signal the hypothalamus to decrease production of GnRH, thus forming a feedback control loop.
Levels of testosterone and estradiol are just two of the influences on GnRH production and release.
Many neurotransmitters may influence the GnRH secretory pattern, and endogenous and exogenous opioids exert an inhibitory effect on GnRH.
Opioids decrease LH while opiate antagonists (eg, naloxone hydrochloride) increase these hormone levels. Although opioids’ affect on LH and subsequent sex hormone release is not completely understood, opioids may alter the sex hormone–hypothalamic feedback process.
Adverse effects of sustained-action opioids. Sex hormone deficiency is identified by hypogonadotropic hypogonadism (ie, decreased levels of gonadotropin-releasing hormone, luteinizing hormone, testosterone, or estradiol) or decreased adrenal androgen production (ie, decreased levels of dehydroepiandrosterone and dehydroepiandrosterone sulfate).”
Symptoms of Opioid-Induced Endocrinopathy
Can you see why I quoted so much information from that awesome article?! I’m not a doctor, and it would’ve taken me quite some time to learn all that info and then put the concepts into my own words.
Now that you’ve been educated on the physiology of Opioid-Induced Endocrinopathy, let’s go over the common symptoms that result from this disorder.
Common symptoms of Opioid-Induced Endocrinopathy include:
- Decreased Libido
- Decreased Muscle Mass
- Erectile Dysfunction
- Hot Flashes
- Menstrual Irregularities
- Vasomotor Instability
- Weight Gain
Which Opioids Cause Opioid-Induced Endocrinopathy?
Any opiate or opioid drug can cause Opioid-Induced Endocrinopathy. However, the sustained-action opioids (especially methadone) are much more likely to cause significant endocrinopathy than short-acting opioids.
According to the article, I quoted previously, “Opioid-induced endocrinopathy should be considered in any patient receiving daily opioid treatment in an amount equivalent to 100 mg of morphine or more.
In addition, patients should be asked routinely about symptoms suggestive of sex hormone deficiency before treatment and at regularly scheduled follow-up medical visits.”
What is the Treatment Protocol for Opioid-Induced Endocrinopathy?
If you’ve been identifying with some of the symptoms associated with Opioid-Induced Endocrinopathy, you may have a mild, moderate, or severe case of this disorder. Luckily, there is hope. Researchers have found ways to reverse Opioid-Induced Endocrinopathy.
Here are some recommended treatment protocols for Opioid-Induced Endocrinopathy:
- Supplementation – Testosterone for men, and 50 to 100 mg of DHEA for women (or testosterone for women but only 1/4 the amount needed for males).
- Opioid Rotation – Patients who gained weight when receiving long-term treatment with morphine or methadone subsequently lost substantial weight when rotated to oxycodone or buprenorphine.
Step-By-Step Plan of Action if you Think you have Opioid-Induced Endocrinopathy
If you are experiencing any of the symptoms of Opioid-Induced Endocrinopathy, or if you’re on over 100 mg of morphine or the equivalent, and especially if you’re on methadone, I recommend going to your doctor for a checkup.
Since most doctors are clueless about Opioid-Induced Endocrinopathy, I also highly recommend printing out the article I referred to in my post in a PDF format to show your doctor.
There are several ways you can create a PDF file from a web page. Google it if you don’t know how. If it’s above your technical ability and you also don’t know anyone that can help you do this, you can just show your doctor the article on your smartphone.
Opioid-Induced Endocrinopathy Success Stories
I’ve already posted Rowan’s success story he wrote about using testosterone therapy to reverse his severe case of Opioid-Induced Endocrinopathy. And now I’m going to travel back in time to when I was a methadone counselor yet again.
Toward the end of my time working at the methadone clinic, one of the counselors quit. The Clinical Supervisor (CS) divided up the counselor’s caseload between me and the other counselors and I received several new patients.
One of those patients was a 45-year-old male that told me the following:
- He had been on 140 mg of methadone for six years.
- He suffered from massive weight gain, low libido, erectile dysfunction (ED), fatigue, depression, loss of muscle mass, and many other symptoms associated with Opioid-Induced Endocrinopathy.
- After years of enduring these awful symptoms, he told his doctor and as a result was prescribed testosterone.
- He stated that the testosterone injections took away nearly all of his symptoms and as a result, he was much happier and healthier while taking 140 mg of daily methadone.
A Disturbing True Story
At the time I was counseling the patient that told me of his success using testosterone therapy to reduce his symptoms from methadone, I was still ignorant about Opioid-Induced Endocrinopathy. However, after I learned about this disorder, I called the methadone clinic where I used to work to share this important information.
I figured that the Clinical Director, nurses, and doctors that worked there would be overjoyed about this, as, from my estimation, at least 70% of all the patients there (over 350 patients) suffered from Opioid-Induced Endocrinopathy to at least some degree, and it was apparent that many had severe cases.
So I told the Clinical Director who runs the facility, and she got excited and told me she planned on telling the doctors to start educating new patients about this disorder and to begin testing current patients for Opioid-Induced Endocrinopathy.
Unfortunately, she never told a soul.
The methadone clinic was for profit and operated under a “Business Model” of treatment. Thus, the people “running the show” were always trying to increase admissions and retention.
Patients were commonly complaining of all these symptoms associated with Opioid-Induced Endocrinopathy, but due to ignorance on the part of counselors, supervisors, and even nurses and doctors, patients were often told weight gain was due to getting clean and possibly poor eating habits as well.
While there was validation that methadone was obviously responsible for some side effects, there was never a legit diagnosis of Opioid-Induced Endocrinopathy, nor a treatment protocol to help these methadone patients reduce or eliminate these symptoms.
What do you think would happen to the admission and retention rates of the methadone clinic if now the patients had a real answer to just how much methadone can screw up your endocrine system and thus physical and psychological health?
I’ll tell exactly what would happen…
Admission and retention rates would go down significantly, and thus so would profits.
Over time, more and more people would learn about Opioid-Induced Endocrinopathy, and this particular company I used to work for had clinics all over the nation.
Perhaps in a few years time the fact that methadone caused Opioid-Induced Endocrinopathy would become mainstream and thus all clinics would see a drop in profits, leading to much fewer profits than if it only affected the one clinic that I used to work at.
You know what?
I attended weekly employee meetings for two years while working as a counselor at a methadone clinic. Sadly, there was not a single meeting where an item on the meeting agenda was “how to help people get off methadone.”
Instead, the meeting agendas constantly were on “how to increase admits, how to increase retention, and how to make sure patients on MediCal came to their counseling sessions.”
The company I worked for billed MediCal a lot of money per counseling session the patient had and that was the primary way the company made money.
Cash patients would only have to see a counselor 1x per month, but patients with MediCal would have to start off with 60-minute counseling sessions 4x a month because the methadone facility would then be able to make way more money.
That is just one of the many reasons I decided to give my two-weeks notice and start my own company for helping people recover from opiate addiction.
I just went off on an unplanned tangent on this subject, but hey, you should be aware of these types of things. I am a big advocate of Harm Reduction and Medication-Assisted Treatment, and I think methadone and other sustained-action opioids are very helpful to a lot of patients.
But it would also be nice if the doctors and treatment programs prescribing opioids were aware of Opioid-Induced Endocrinopathy and how to diagnose and treat it. That would literally help increase the quality of lives of millions of patients taking these drugs for pain relief and/or opioid addiction.
Opioid-Induced Endocrinopathy – Key Concepts
Millions of patients continue to require opioid analgesics for control of moderate to severe chronic pain, which is a disease that affects more Americans than cancer, heart disease, and diabetes combined. Additionally, there are millions of people without pain syndromes that are addicted to opioids or are taking Opiate Replacement Medications such as methadone for opiate addiction.
While most doctors and patients are aware of the common opioid effects such as sedation, constipation, pain relief, and nausea, hardly anyone has ever even heard of Opioid-Induced Endocrinopathy, despite the fact that millions of people are suffering from this disorder to at least some degree.
Here are the key concepts regarding Opioid-Induced Endocrinopathy which I synthesized from the article I previously quoted:
- Opioid-Induced Endocrinopathy is one of the most common yet least often diagnosed consequences of prolonged opioid therapy.
- Any opiate or opioid drug can adversely affect endocrine function and reduce testosterone and cause low libido and other side effects.
- Long-acting (aka sustained-action) opioids used for a month or longer can lead to Opioid-Induced Endocrinopathy.
- The severity of symptoms depends on a number of factors, some of the main ones being the type of opioid (methadone causes symptoms the most) used, the dosage, and the length of time taking opioids.
- Doctors prescribing opioids (and nurses too) should be educated on Opioid-Induced Endocrinopathy.
- Doctors should tell their patients about the possibility of them getting this disorder if the patient is receiving daily opioid treatment in an amount equivalent to 100 mg of morphine or more.
- Patients should report any symptoms associated with Opioid-Induced Endocrinopathy to their doctor as soon as possible.
- Current treatment approaches for Opioid-Induced Endocrinopathy are an opioid rotation, testosterone therapy, or 50-100 mg of daily DHEA supplementation for females.
- Testosterone supplementation should be administered in amounts needed to manage symptoms of hypogonadism (amounts higher than needed may increase the risk of prostatic hypertrophy and prostate cancer).
- In the United States, DHEA is available as a dietary supplement and is marketed with claims that daily treatment will decrease postmenopausal bone loss and improve muscle strength, sexual performance, and memory.
- Female patients with suspected androgen deficiency who are receiving long-term opioid treatment have reported increased energy, increased libido, and weight loss with DHEA supplementation.
Here’s a simple breakdown for doctors which I’m quoting from the same article I’ve been referencing:
- After opioid treatment is initiated, patients should be routinely evaluated for signs and symptoms of endocrinopathy.
- Testosterone supplementation is the primary treatment option for men, while DHEA supplementation may be preferred in women.
- Because some opioids may result in less endocrine dysfunction than others, rotation to a different opioid may also be an appropriate treatment option, particularly for women.
Opioid-Induced Endocrinopathy Conclusion
Low libido and sexual dysfunction can cause significant problems in intimate relationships. Fatigue and depression can lead to extreme difficulty working, running a business, parenting, and enjoying life.
Undiagnosed and untreated Opioid-Induced Endocrinopathy due to unintentional (yet harmful) ignorance is causing so much needless suffering. Please help me spread awareness by sharing this article with anyone that you think would benefit from it.
If you have any comments or questions about Opioid-Induced Endocrinopathy physiology, signs and symptoms, diagnosis, and treatment, please post them in the comment box below.