The BEST Diagnostic Tests Needed By Opioid Pain Medication Users

  • Opioid medication use does come with a certain degree of risk. Doctors are not only supposed to talk about the risks associated with long-term opioid use, they are also supposed to monitor for potential consequences. When the risks begin to outweigh the benefits, treatment plans may need to change in order to keep patients out of harm’s way. Four tests are critical to help ensure that no harm is done.


    • Bone Density Screen: Anyone who has been using opioid medications is at higher risk for weakening bones. In fact, nearly 50% of people using opioids are either osteopenic or osteoporotic regardless of the testosterone level. This risk can be directly related to the effects that opioid medications have on the hormonal system or related to the some other unknown mechanism. Regardless, long-term opioid use seems to put the skeletal system in harm’s way (see Testosterone Level below).1

    • EKG: Anyone who is taking methadone absolutely needs to have an EKG. Sudden death has occurred numerous times in those taking methadone and is caused by electrical disturbances in the heart. Specifically, the QT interval needs to be watched closely. If it is creeping over 450 towards 500, a doctor may want to consider lowering the dose. If the QT interval is above 500, then the methadone dose definitely needs to be reduced. The cardiac electrical abnormalities are reversible when the methadone dose is reduced. As a rule, an EKG should be done before the methadone is initiated, 30 days after it is initiated, and annually thereafter. EKG monitoring in those using methadone is a matter of life or death.2

    • Sleep Study: 75% of people taking opioids will have some form of obstructive sleep apnea. What’s the big deal about sleep apnea? For one, vehicle accidents are a pretty big deal. Those with sleep apnea are much more likely to get into a severe accident than someone who does not have sleep apnea. Other problems associated with sleep apnea include: high blood pressure, heart problems, fatigue, and a sleep deprived partner. Sleep apnea is reversible if the opioid doses are reduced.3

    • Testosterone Level: 57% of men are considered hypogonadal (low testosterone level) within three months of using opioids. The testosterone levels can plummet even after the first dose. Of those that have low testosterone levels, 74% are on long-acting opioids. For some reason, the long-acting opioids really mess up the hormonal system profoundly and quickly. This consequence is also reversible with lower doses of opioid medications. 4


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    These tests are the BEST diagnostic tests for anyone using opioids for long periods of time. These tests monitor for the most significant consequences associated with long-term opioid use and help to ensure that the risks do not start to outweigh the benefits. Ask your doctor to order the BEST tests today. 


    1. Pain Physician. 2008 Jul-Aug;11(4):539-41
    2. Am J Cardiol. 2013 Oct 1;112(7):1013-8
    3. Pain Med. 2008 May-Jun;9(4):425-32.
    4. Am J Med. 2013 Mar;126(3 Suppl 1):S12-8
Published On: October 28, 2013