Opioids and Kidney Health

Opioid abuse has become an epidemic in the U.S. The rate of people who die from opioid overdoses was 6 times higher in 2017 than in 1999. Every day, about 130 Americans lose their lives due to an opioid overdose. 



Though sobering, these statistics do not tell the whole story of the effects of opioid use and abuse. Many patients who do not die from using opioids still experience significant negative side effects. Last month was American Heart Month, so we took a deep dive into opioids and heart health, which you can read about here. March is National Kidney month, so let’s take a look at how opioids affect a person’s kidneys.

Do Opioids Cause Kidney Disease?

Some doctors have noted the prevalence of kidney disease among opioid users and wonder if there may be a relationship. It makes sense, the kidneys help cleanse the body of toxins, and a constant supply of strong toxins could overtax the organs. 


However, effectively studying a causal link between opioids and kidney disease proves to be challenging. Those who use prescription opioids presumably already have some kind of health issue that requires pain management, thus making it more difficult to isolate a cause. Those who use opioids illicitly are also not the healthiest individuals — and often do not provide honest answers to medical questionnaires. 


man with pill bottle

An additional problem is knowing to what medication the individual has been exposed. Illicit drug users often use different methods of delivery, products with different drug formulations, or use drugs that have been adulterated with something else. However, doctors have noted that some symptoms experienced by opioid abusers are related to acute kidney injury (AKI). These include:

 Dehydration caused by opioid overdose
 Urine retention
 Rhabdomyolysis (muscle death)

One small study found that just under half of patients with a history of injecting oral opioids had some degree of acute kidney injury. Though most recovered with treatment, some (13.9%) progressed to end-stage renal disease and some (7.6%) died in the hospital (not necessarily from an overdose or related condition). It is important to note that not all studies have found a link between AKI and drug use. But self-reporting is often used when studying illicit drug use and this method, for obvious reasons, is not always reliable. 

What if You Already Have Kidney Disease?

Kidney disease is a painful condition and patients already face limited drug choices for pain management. For example, even an unassuming drug like over-the-counter ibuprofen is not recommended for patients with kidney problems. This type of drug has been found to potentially cause greater damage to the kidneys. For this reason, many doctors prescribe opioids for pain management in these patients. To date, studies have not found that opioid use results in the same adverse effect on the kidneys.


However, some doctors warn that opioid use of this nature can still be dangerous. For example, part of the function of the kidneys is to remove toxins from the body. Opioid medications contain a certain amount of toxicity. For most people, it is not enough to be a problem because their kidneys take care of it. But, in people with low-functioning kidneys, it makes sense that the toxicity would remain in the body longer than it should, potentially causing illness. More study is necessary on this topic to fully understand the implications of patients with kidney disease taking opioids. 

Opioids and Death

An interesting study to note is one that was published earlier this year. Without regard for hospitalization reason, overdoses, kidney function, or anything else, researchers examined 100,000 patients in Pennsylvania. 


What they found was both shocking and sobering.


Patients who filled their opioid prescription had about 1.5 times higher chance of death than those who did not have an opioid prescription. While the study doesn’t prove a direct causal link, it certainly should give doctors and patients pause before prescribing or taking opioid medication. Even if the direct risk of death wasn’t higher, the prevalence of opioid addiction among patients taking prescription medication is too high to ignore. 

Alternatives to Opioids for Pain Management

In short, the jury is still out on whether opioids can damage the kidneys or cause or worsen kidney disease. Regardless, there are plenty of reasons to avoid taking opioids as much as possible.

Some safe alternatives to opioids for pain management include:

• Physical therapy
• Hot and cold therapy
• Acupuncture
• Exercise
• Massage
• Rehabilitation therapy
• Medication Assisted Treatment

Many alternatives require a bigger time commitment that simply taking a pill. Some, like physical therapy or exercise, may cause additional pain before beginning to ease your symptoms. Medication assisted therapy is a good alternative because it combines supervised medication use with therapy, ensuring the person receives a more complete recovery process.


group therapy


The bottom line is that all of these therapeutic alternatives are a better choice than opioid abuse. Investing in good health, whether it be time or money, is the best investment you can make for yourself. 

About the Author

Paula Nicola, M.D.
Dr. Nicola is the Facility Director at Renu. She is a trained and board certified medical doctor with specialized training in addiction medicine.

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