The hidden effects of opioid use on the endocrine system

A new Scientific Statement released today by the Endocrine Society highlights research gaps associated with the negative effects of opioid use on the endocrine system.

The use and misuse of opioids are a growing global problem. Opioids are used to treat pain in people with cancer or other conditions (e.g., after an injury or surgery), however, they are highly addictive and people can develop opioid use disorder (OUD). The World Health Organization estimates 125,000 people died of opioid overdose in 2019.

The use and misuse of opioids has a negative effect on our hormones and can lead to reproductive, bone and adrenal health complications.

“Exogenous Opioids and the Human Endocrine System: An Endocrine Society Scientific Statement,” reviews data related to the use and misuse of opioids and the effects of these drugs on the endocrine system. The Statement discusses recent research on the clinical consequences of opioids, especially on the hypothalamic-pituitary system and bone health.

We address the many research gaps associated with the effects and clinical consequences of opioids on the endocrine system within this Scientific Statement. We hope bringing attention to recent research in the space, including opioid use’s impact on gonadal, bone and adrenal conditions, will improve the endocrine health of people using or misusing opioids worldwide.”

Niki Karavitaki, M.Sc., Ph.D., F.R.C.P., lead Statement author of the University of Birmingham, Birmingham Health Partners, and the University Hospitals Birmingham National Health Service Foundation Trust in Birmingham, U.K.

The Statement reviews research related to the impact of opioids on gonadal and adrenal function, and bone health. The authors report male hypogonadism, a reproductive health condition that causes low testosterone, as a well-recognized side effect of opioids, and provide more clarity around the drug’s lesser-known effects on other parts of the hypothalamic-pituitary system and bone health. They discuss the link between opioids and the development of hyperprolactinemia and how more research is needed to understand their effect on secondary adrenal insufficiency. 

The Statement authors also assessed how opioids affect the secretion of certain hormones to better understand the connection between opioid use and endocrine disease. These hormones include growth hormone, arginine vasopressin (regulates the body’s water balance), and oxytocin (plays a crucial role in the childbirth process).

They also reviewed research into opioid’s actions on bone metabolism and their negative impact on bone mineral density and risk of fracture.

“Clinicians need to be aware of these endocrine health consequences and monitor patients who are using opioids more closely for signs and symptoms of them,” Karavitaki said.

Other statement authors are Jeffrey Bettinger of Saratoga Hospital Medical Group in Saratoga Springs, N.Y.; Nienke Biermasz of Leiden University Medical Center in Leiden, The Netherlands; Mirjam Christ-Crain of the University Hospital Basel and the University of Basel in Basel, Switzerland; Monica Gadelha of the Universidade Federal do Rio de Janeiro in Rio de Janeiro, Brazil; Warrick Inder of Princess Alexandra Hospital, Brisbane, and the University of Queensland, Brisbane, in Queensland, Australia; Elena Tsourdi of Technische Universität Dresden in Dresden, Germany; Sarah Wakeman of Massachusetts General Hospital, Mass General Brigham and Harvard Medical School in Boston, Mass.; and Maria Zatelli of the University of Ferrara in Ferrara, Italy.