It appears that opioids can cause adrenal insufficiency. This is something I have not seen mentioned here. Does anyone know about this? Here are a few articles. I think this has relevance to anyone trying to taper through the lower doses of pred if they are taking opioids for pain or any other reason.
In the second article, there is also this interesting statement... "In studies in healthy volunteers, administration of high doses of intravenous naloxone (>10 mg), an opioid receptor antagonist with a higher affinity for the μ receptor, led to increased cortisol levels and an augmented corticotropin response to corticotropin-releasing hormone (CRH) stimulation."
Could naloxone (high or low dose) be helping in coaxing the adrenals back online?
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sferios
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Not mentioned here for the pure and simple reason opioids do nothing for PMR/GCA pain. So no-one is on them for PMR. Some may be on them for other things.
LDN, low dose naltrexone, is said to be a way of managing PMR. Naloxone is what is used in emergency reversal of opiod overdose, low dose naltrexone is used in opiod use disorder.
I am just trying to help people. I have worked work in harm reduction and recovery for 25 years and know there are a lot of people who use opioids but do not admit it due to the stigma associated with them.
My apologies if I came across as certain. I try to be skeptical of of everything. I was just sharing information that might be relevant to people.
you have helped me. I read these articles and they are very interesting to me. I have been on morphine for 7 years and have never been told about adrenal insufficiency. Now I know, I will keep it in mind. I don’t take morphine for PMR but for Ankylosing Spondylitis and Degenerative Disc Disease.
Opiod overuse is indeed a major health problem in the USA, but looking at your other posts today , maybe best to get yourself sorted out at the moment?
My career is a testament to helping people with substance use disorders. Your assumptions (incorrect, mind you) belie a prejudice unbecoming to this forum.
Maybe it was meant in a different sense, You really can't help a lot in PMR UNTIL you understand the way it works - as evidenced by your difficulty in grasping our explanations because you don't quite get the basics.
Often a problem on the forums as you don't hear the tone of voice or see the laugh that may go with it. Just imagine it in different tones of voice ...
Perhaps So no-one is on them for PMR pain relief. I am not on them for pain relief ~~ BUT ~~ I have taken 3x30mg of Codeine daily since 2013 to help manage my incontinent bowels following a colectomy and the construction of an ileo-anal internal pouch.
Thank you. I am also in the (hopefully) final stages of tapering. I am on 3mg and am awaiting the result of my recent Synacthen test. It could be interesting to find if the Codeine has any effect on this.
I think the evidence is 100% conclusive that opioids suppress the HPA Axis. I've been reading about it now for the past two days. There are dozens and dozens of scientific articles about it. There are even studies, like this one, that use naloxone in certain autoimmune patients to assess whether their low adrenal functions is caused by having too much endogenous opioids.
Scientists use naloxone to stimulate adrenal function because it is an opioid blocker (endogenous and exogenous both).
I don't know why my post here resulted in some people accusing me of being stupid or uneducated. Also, I meant no offense to anyone. My statement that I had not seen this phenomenon mentioned here was not meant as an accusation of neglect. Nor was it an effort to gloat over how much I supposedly know. I know very little about all this.
Basically, I found some information and because I feel indebted to this group, I wanted to give something back.
I appreciate the thanks I received from the handful of people who made comments saying this post did, in fact, help then.
For me, I discovered these articles because I was trying to figure out what I can do to bring my own adrenal functioning back on quicker (now that I am at 6.5 mg of pred, I want them tot start ramping up).
And similarly, I do not not want to take anything that might suppress my adrenals.
It actually began with read a post from a few months ago about CBD, which I was taking in large doses every night. It wa a shock to learn that CBD is metablized through the same liver enzyme pathway as pred, potentiating the pred effect and potentially suppressing the HPA axis.
I just stopped using CBD at night.
So this led me to start researching other substances that affect the HPA axis. People ridicule others who use Google to do research, but Google Scholar (and Pub Med) are excellent resources. The best scientists in the world use these services when they do research. And I quickly found out that opioids suppress cortisol.
This is an established fact, and I wanted to share it with people, to give something back to a community that has helped me so much over the past nine months. That's all I was trying to do.
Thank you. I am struggling with tapering, now at 7mg.I have been on 10 Butans (morphine patch) since major back surgery in 2017. This surgery most probably triggered off my PMR which was finally diagnosed in 2018.
I am now taking methotrexate to assist my taper. This is helping with inflammation in my joints but does nothing to alleviate my stiffness and fatigue. Prednisolone at 8.5 mg was brilliant at doing this. The fatigue is probably related to adrenal insufficiency....interesting to read that opioids came affect adrenal function.
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