Urgent warning for men: Beware “long-acting” chronic pain medications

An estimated 4.3 million Americans use opioids on a daily basis for pain. Of course, there are a number of natural alternatives for managing pain (as I’ve discussed both in this issue and in previous editions of Insiders’ Cures). But if you do take an opioid-based pain relievier (Oxycontin or Vicodin, for example), at the very least, opt for a short-acting version (taken every 4-6 hours) instead of a long-acting one that you take every 8-12 hours.

This may sound like a strange recommendation. And, in theory, long-acting pain medications seem like a good idea: longer relief, less medication.

Indeed, doctors were told for years that these longer-acting opioids would be somehow safer, more effective, and less subject to abuse. Yet no study has been able to show such benefits. However, new research has found a substantial difference between the short-acting forms and the long-acting versions. And the results are, well…painful.

A large study of 1,500 men who are taking pain pills is currently underway. And researchers have already determined that the long-acting medications are causing five times the rate of low testosterone.1

Fully three-quarters of the men on long-acting pain medications had low-T compared with only one-third using short- acting. After controlling for body mass index, the risk of low-T was 4.8 times greater for the men taking long-acting medications. The researchers didn’t attempt to explain why pain medications could cause low-T.

But Dr. Andrea Rubinstein, lead study author, said that “We are now finding that long-term use of opioids may have important unintended health consequences.”

Unfortunately the unintended consequences of “low-T” can snowball. Low-T in turn causes decreased muscle mass, bone density (osteoporosis), cognition (dementia), mood (depression), libido and generally poor quality of life. All of these are in turn associated with chronic pain as well, leading to a greater need for pain medications—a viscious cycle.

We have commented before on the generally poor quality and status of politically-based (rather than science-based) pain medicine (See the Premier issue of Insiders’ Cures for more on that topic).

These latest results regarding what should be nature’s most effective form of relief are painful indeed. But for many conditions you can skip the opioids and go with one of the other natural remedies I discussed a few months ago in the March 2013 issue.


1. “Hypogonadism in Men With Chronic Pain Linked to the Use of Long-acting Rather Than Short-acting Opioids.” The Clinical Journal of Pain 2013 DOI: 10.1097/AJP.0b013e31827c7b5d