Prescription opioids are often used to treat moderate, severe, or chronic pain — a condition that affects 50 million Americans. However, opioid use has the potential for harmful side effects, which include cardiovascular risks.
This article was originally published in 2017 and was last updated in 2025.
Study Links Prescription Opioids to Cardiovascular Disease
Researchers looked at 50,000 patients, 30% of whom had received prescribed opioids over three years. They found that patients who were prescribed opioids were significantly more likely to develop cardiovascular disease (CVD) later. The researchers also found that higher opioid prescribing doses were associated with a higher risk of CVD.
Chronic pain is especially prevalent among those 65 and older—impacting as much as 60 to 75% of aging adults.
“Chronic pain is one of the most common conditions that older adults experience,” says Minhee Sung, MD, instructor of medicine (general medicine & addiction medicine) and first author of the study. As this population may already be at increased risk for heart issues, the possibility of opioid-related cardiovascular disease creates an even greater risk.
Cardiovascular Death May be More Prevalent than Overdose Deaths
Researchers at Vanderbilt University found that people who take opioids for chronic pain are far more likely to die from cardiovascular or respiratory problems than they are from accidental overdose.
They found that over twice as many opioid-receiving patients died from cardiovascular or respiratory problems than overdose.
“The increased risk of cardiovascular death could be related to adverse respiratory effects of long-acting opioids. Opioids can cause or exacerbate sleep-disordered breathing, including both obstructive and central sleep apnea,” said lead study author Wayne Ray, PhD, of the Vanderbilt University School of Medicine.
Dr. Ray went on to warn that previous research on opioid mortality may have substantially underestimated the true risk of opioids by misclassifying patient deaths as unintentional overdoses.
Opioids May Increase Risk of AFib and Heart Attack
Taking opioids may increase your risk of developing an irregular and often rapid heartbeat, a condition known as atrial fibrillation or AFib.
AFib is an often symptomless condition where the heart’s upper chambers beat out of sync with the lower chambers. When symptoms do appear, they can include shortness of breath, fatigue, and heart palpitations. Researchers have found that AFib can increase the overall risk of a heart attack by 63%, with a higher rate of risk for women.
In a study published in JAMA Internal Medicine, researchers found a higher prevalence of AFib in opioid users compared to non-users. The researchers also noted an increase in both opioid use and cases of atrial fibrillation in the United States over the past decade. They recommended more research be done on the connection between the two.
Opioids + Benzodiazepines: a RX for Heart Danger
Opioid use can be associated with decreased cardiac function when administered in combination with other prescription medications, especially benzodiazepines.
Benzodiazepines are a type of sedative commonly prescribed to treat anxiety or insomnia. Commonly prescribed benzodiazepines include diazepam (Valium), alprazolam (Xanax), and clonazepam (Klonopin).
More than 30% of opioid overdoses also involve benzodiazepines.
According to a study published in The Ochsner Journal, severe adverse side effects can occur when benzodiazepines are combined with opioids. Both cardiovascular and respiratory risks are enhanced dramatically when the two drugs combine.
Are anti-anxiety medications giving rise to the next US drug epidemic?
Heroin Use Associated with Fatal Heart Infection
Hospitalizations for heart valve infections often attributed to intravenous drug use have increased significantly, according to a study by researchers from Tufts Medical Center and Tufts University School of Medicine.
Infective endocarditis (IE) is an infection of the heart valve that can be lethal and is often triggered by intravenous drug use. Among drug users, most endocarditis infections stem from the use of non-sterile syringes, allowing bacteria to enter the bloodstream and, eventually, the heart.
Infective endocarditis from intravenous drug use (IDU) has increased over the past two decades. A sample of US hospitalizations from 2000 to 2013 showed that IE hospitalizations rose 38% overall, but hospitalizations for intravenous drug use-related IE increased by 238%.
The steepest increase in IE related to drug use occurred from 2020 to 2022 amid the COVID-19 pandemic.
The groups who saw the largest increase in IE were white young adults, ages 15 - 34, and women.
“We’re seeing a shift toward youth, white youth, and women, and it’s likely that we’ll continue to see even higher increases. It’s a much more suburban problem than most people realize,” said senior author Thomas Stopka, PhD, assistant professor of public health and community medicine at Tufts University School of Medicine. Stopka specializes in the epidemiology and geospatial distribution of infectious diseases and substance abuse.
Heroin use has increased five-fold in the last decade amidst the nation’s devastating opioid epidemic. “Over the past decade, we have found a significant increase in heroin use across almost all demographic groups,” said Dr Christopher M Jones, senior adviser at the Food and Drug Administration (FDA).
This increase in heroin use is closely tied to the increase in prescription pain reliever abuse.
Researchers have found a strong positive relationship between heroin and prescription painkiller abuse; as more people become addicted to opiates, either prescription pills or heroin, you see more use of the other.
“Recent CDC research has identified increasing injection drug use - tied to the US opioid epidemic - in rural and suburban areas across the country,” said CDC division director Dr. John Ward.
Medical professionals are also seeing an increase in other intravenous drug-use-related diseases as the opioid epidemic rages; new hepatitis C infections tripled between 2010 and 2015, and the Indiana State Health Department reported an HIV outbreak resulting from intravenous opioid use in 2015.
More than 30% of Americans are affected by acute or chronic pain conditions, and many turn to opioids for relief. The side effects of opioid use, however, can be grave. Opioids can result in mild to severe side effects – like the increases in cardiovascular disease mentioned here.
This post is the second part of our series about the serious side effects of long-term opioid use.
