Oct. 10, 2024 -- Did you hear the recent news that Ozempic, the popular weight loss and diabetes drug, may lower the risk of opioid overdose, according to a new study? The finding may be particularly crucial for people living with diabetes, and here’s why.
People with type 2 diabetes are twice as likely as those without diabetes to take prescription opioids, research shows, potentially making them more vulnerable to misuse and addiction. After all, to develop a problem with opioids, you have to take them first.
“The bottom line is that these medications carry risk, especially when people take them long term,” said Scott G. Weiner, MD, MPH, director of B-CORE: The Brigham Comprehensive Opioid Approach and Education Program at Brigham and Women’s Hospital in Boston. “And pretty much anyone is vulnerable to developing an opioid use disorder when they're taking opioid medications.”
Up to 1 in 4 people who take opioid medications long-term develop opioid use disorder. From 1999 to 2022, more than 300,000 people in the U.S. died from overdoses involving prescription opioids, according to the CDC.
Diabetes is linked with conditions that lead people to seek pain treatment, said Michelle Krichbaum, PharmD, a clinical manager for pain management, palliative care, and opioid stewardship at Baptist Health South Florida, who has researched opioid use trends in patients with diabetes. Among these are arthritis, backaches, ulcers, and peripheral neuropathy (nerve damage to hands and feet that can lead to amputation).
Another 2023 study found that Medicare beneficiaries with diabetes were more likely to receive opioids if they had complications -- including neuropathy, a history of amputation, high blood pressure, obesity, heart disease, or peripheral vascular disease. The risk also went up with related diseases of the liver and lungs, as well as depression and alcohol or drug abuse.
“The No. 1 thing is making sure your diabetes is managed appropriately,” said Krichbaum. “That in itself is going to lower your risk of other comorbid diseases that are painful, thereby reducing your risk of needing analgesics of any kind” -- including opioids.
If you’re living with diabetes and concerned about opioids, consider this advice from the experts.
Try other pain meds first. Opioids should be the last resort, said Weiner. “They're just too dangerous.” Be sure you and your doctor have explored other options, like anti-inflammatories for arthritis or nerve medications for neuropathy. (Nonsteroidal anti-inflammatory drugs like ibuprofen may not be suitable if you have kidney or heart problems, said Krichbaum.)
Consider nondrug options. Ask your doctor for a referral to a pain management psychologist. “So much of pain is how the individual interprets it and catastrophizes around it,” said Weiner. If you feel like your pain is the end of the world, or if you expect pills to vanish every single ache, you might be more prone to opioid use disorder. A psychologist can help you reframe pain, helping you cope better and easing discomfort. Also think about acupuncture, tai chi, physical therapy, or yoga – all have been shown to help with pain.
Ask questions. Before starting an opioid, “you really need to ask the doctor: Should I be on this? How can I take it safely? What will be the plan to make sure that I'm doing OK and I'm not developing misuse of the medication or use disorder?” said Weimer. Also ask how long you’ll need the medication, and discuss a plan for weaning off it someday.
Talk to your doctor about Ozempic. Circling back to that new study linking semaglutide to opioid overdose prevention: “We think what's happening is it's kind of dulling the pleasure response to things like food or, in this case, opioids,” said Krichbaum. She is cautiously optimistic but said more research is needed before the drug can be prescribed to treat opioid use disorder. However, if you’re considering Ozempic for obesity or diabetes, talk to your doctor about this potential added benefit.
Discuss a pain relief plan before having surgery. In a Stanford University study, people with type 2 diabetes who took opioids post-surgery were 56% more likely to keep using them 3 months later than post-op patients without diabetes. Ask your doctor about the risks and benefits of opioids versus other options. “It is a balance,” said study author Tina Hernandez-Boussard, PhD, a professor at Stanford Medicine. “If you have, for example, a knee replacement surgery, it's very important for recovery that you get on that knee and you start walking and moving around.” You want enough pain relief that you can start moving (to help speed healing and recovery) while remaining mindful of medication risks.
Remind your doctor about your other health problems. Some make opioids more dangerous. Sleep apnea can raise the risk of opioid-induced respiratory depression, or shallow breathing, said Weiner. Impaired kidney or liver function can slow the breakdown of opioids in the body, said Krichbaum, so the drugs take longer to leave your system, increasing the risk of a bad response. Speak up, too, if you have a history of alcohol use disorder or childhood trauma — both make opioid use disorder more likely.
Take precautions. Ask for a prescription for naloxone (Narcan), or get it over the counter at the pharmacy, said Weiner. This drug can reverse an opioid overdose in minutes.
Know the signs of trouble. Take opioids exactly as prescribed, and watch for signs of withdrawal or tolerance — needing higher doses. Red flags: seeking prescriptions from different doctors, filling scrips early or worrying about refills, missing social obligations, using the drugs for sleep or emotional pain, thinking excessively about your next dose, or using opioids you weren’t prescribed.
If you suspect a problem, or if friends or family members express concern, answer these questions:
- Have you ever felt the need to cut down on your opioids?
- Do you feel annoyed by people complaining about your drug use?
- Do you ever feel guilty about your drug use?
- Have you ever used drugs first thing in the morning to steady your nerves or start the day?
“If you're answering yes to two or more of those, or even one or more of those but you're starting to be concerned, I think it's reasonable that you go to your physician,” said Krichbaum. Ask if they can check you for opioid use disorder.
One treatment for opioid use disorder is buprenorphine, a medication with pain-relieving properties. As an extra benefit: When people with diabetes receive opioid use disorder treatment, their blood sugar control often improves, too, likely because they start taking better care of themselves, said Devon Tilbrook, MD, a family doctor in Ontario, Canada.
“If you have an opioid use disorder and you have diabetes, getting your opioid use disorder under control would benefit your diabetes and your sense of well-being greatly,” she said. “Likewise, it seems getting your diabetes under control benefits your opioid use disorder.”
