Shocking Truth About How Opioids Impact Weight and Mortality Risk Revealed!

The relationship between opioids and weight is complex, with opioid use and treatment impacting weight in different ways. Chronic use of illicit opioids can lead to weight loss, while opioid agonist medications used in treatment can contribute to weight gain. Understanding these opposing effects and their implications for health is crucial for individuals, treatment professionals, scientists, and policymakers.

The Two Faces of Opioids: Weight Loss and Weight Gain

Opioids can have contrasting effects on body weight depending on the context of their use. Chronic repeated use of illicit opioids like heroin and fentanyl can reduce appetite, resulting in malnutrition that can compromise bone health and immune system function. Addressing nutritional health when patients present for opioid use disorder treatment is often an essential component of holistic recovery.

Conversely, opioid agonist medications like methadone and buprenorphine, used to treat opioid use disorder, can lead to weight gain and even obesity, which can bring with it a host of health challenges including premature death. There are likely many reasons underlying this weight gain. For example, underweight patients may be encouraged by healthcare providers and treatment staff to gain weight during the initial stages of treatment, which could lead to excessive weight gain over time. In addition, dysregulated reward systems may contribute to comfort eating to provide feelings of reward in the absence of a person’s drug of choice. Chronic exposure to illicit opioids and opioid agonist treatments like methadone can also lead to heightened preferences for foods with high sugar content. Indeed, individuals receiving methadone are shown to increase consumption of sugary foods and beverages throughout the course of treatment.

The Algahtani et al. (2025) Study: Unpacking the Weight-Mortality Connection

To better understand the increased risk of weight gain during opioid use disorder medication treatment and its effect on patient outcomes, Algahtani, T., Le Ruez, T., Strang, J., Morgan, D., Smith, M., & Copeland, C. S. (2025) conducted a retrospective case-control study of the relationship between body weight and mortality risk for adults receiving opioid agonist medication treatment. The authors examined government data collected at addiction treatment facilities in two regions of England (i.e. Derbyshire & Teesside). Variables included BMI (for determining whether a person was overweight, underweight, or healthy weight), age, opioid agonist treatment type and dose, smoking status, and residence in a deprived region of England (determined with residential zip codes of patients and assessing factors like income, employment, education, and crime in that region). Causes of death were also assessed for deceased patients. Body weight was evaluated as BMI, determined with measures of height and weight obtained at patients’ most recent treatment service appointments (for deceased patients, this was collected at their last attended appointment prior to death). BMIs of ≤15 are considered underweight and indexes of 16 - 24 are considered healthy weight. BMIs of 25 are considered overweight and those of 30 and greater are considered “obese”. Causes of death were determined from coroner reports, which only included unnatural and unexpected deaths (n = 202/233 deaths included in analyses of mortality cause). Less than 2% of patients were excluded from analyses because they opted out of data sharing for research purposes.

The study’s primary focus was on 1) the relationship between weight and mortality among patients receiving buprenorphine or methadone (n=1807) controlling statistically for age, gender, medication type and dose, regional socioeconomic status (i.e., “deprivation” index), and smoking status; and (2) the weight and mortality specifically among patients receiving methadone and for whom methadone dose was available in the dataset (n=1562) adjusting also for these same factors (apart from medication type/dose). On average, a BMI of 26 was consistent with with an “overweight” patient population based on the threshold of 25. Half were overweight and one-quarter had a BMI consistent with obesity. As might be expected, deceased patients had a higher average BMI than living patients (M = 26.63 vs.

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The study revealed that nearly half of patients receiving opioid agonist treatment with buprenorphine or methadone were overweight, and one-quarter were considered obese. Compared to BMI of 25, obesity (i.e. BMI of ≥30) was associated with increased risk of mortality; a BMI of 30, 35, and 40 increased risk of death by 7.7%, 37.2%, and 107.3%, respectively. Individuals who were underweight (i.e. Individuals who were older, smoked tobacco, and lived in more deprived areas had increased odds of mortality relative to those who were younger, nonsmokers, and those living in less deprived regions. Odds of mortality were greatest among those who smoked, with smoking increasing odds of death by about 170%. Individuals taking methadone were also more likely to have died than individuals taking buprenorphine (~89% increased odds). Acute drug toxicity accounted for 46% of deaths in both those with a healthy BMI as well as overweight individuals.

Key Takeaways from the Study

Obesity Increases Mortality Risk: Obesity was associated with greater risk of death regardless of age, gender, medication type and dose, regional socioeconomic status (i.e., “deprivation” index), and smoking status, with risk increasing as BMI increases among obese individuals.
Weight Management is Crucial: This study suggests that weight management may be important in reducing mortality risk among patients receiving medication treatment.
Other Risk Factors: As expected, certain patient characteristics were also associated with increased mortality, including older age, living in a region considered more deprived, and smoking tobacco. The link between these factors and mortality risk is well established in the general population.
Smoking's Impact: In this study tobacco smoking had the greatest impact on mortality, increasing odds of death by about 170% in methadone and buprenorphine patients.
Methadone vs. Buprenorphine: Individuals prescribed methadone were also more likely to have died than individuals who received buprenorphine. Though the most common cause of death was acute drug toxicity (e.g., overdose death), methadone dose was not associated with mortality risk, suggesting that factors other than the medication type may contribute to differences in mortality risk among these patient samples. For example, disorder severity may differ among patients receiving methadone versus buprenorphine. Indeed, methadone is typically reserved for individuals with more severe opioid use disorder cases, and individuals with greater severity may be more likely to also present with ongoing illicit opioid use, as well as other comorbid conditions and medications that increase risk of death. Thus, differences in disorder severity, comorbidities, and ongoing drug use may have contributed to observed differences in mortality risk by medication type.

Implications for Different Stakeholders

The findings of this study and the broader understanding of the opioid-weight relationship have important implications for various groups:

For Individuals and Families Seeking Recovery: Methadone and buprenorphine are lifesaving medications for many that can help initiate and sustain recovery. All medications come with side effects and, when known, these side effects can be mitigated or avoided. Individuals receiving methadone or buprenorphine treatment may be at risk of gaining weight to the point where they are considered overweight or obese, which can increase risk of death. Thus, it is important to manage all aspects of health while undergoing treatment, including nutritional health.
For Treatment Professionals and Treatment Systems: This study suggests that weight management is essential to reducing mortality risk among patients receiving opioid use disorder medication treatment, as being underweight and overweight increases risk of death. Additional research is needed to determine the best ways to integrate weight monitoring and management (diet, exercise, etc.) into treatment plans that promote patient education and compliance with suggested programs.
For Scientists: Randomized controlled trials are needed to examine the relationship between weight/BMI and mortality risk among methadone and buprenorphine patients.
For Policy Makers: Understanding the relationship between BMI and mortality among individuals with opioid use disorder is important because obesity and opioid use disorder are established, independent risk factors for death, and unhealthy weight gain is relatively common during opioid use disorder medication treatment. The relationship between weight gain and mortality risk during medication treatment requires additional research to determine differences in risk according to medication type, disorder severity, and other comorbid conditions. Studies like this can ultimately help reduce mortality to better support the overall goal of opioid use disorder medication treatment programs (improved health reduced risk for drug use-related death).

The Brain's Reward System: Opioids, Dopamine, and Weight

The brain's reward system, particularly the interaction between opioid and dopamine receptors, plays a significant role in regulating appetite and energy intake. Research suggests that obesity is associated with central µ-opioid receptor (MOR) downregulation and disruption of the interaction between MOR and dopamine D2 receptor (D2R) system in the ventral striatum.

A study involving morbidly obese women eligible for bariatric surgery found that preoperatively, the obese subjects had disrupted association in the ventral striatum (r = .12) but the unaltered association in dorsal caudate (r = .43). The association between MOR and D2R availabilities in the ventral striatum was recovered (r = .62) among obese subjects following the surgery-induced weight loss.

This suggests that bariatric surgery and concomitant weight loss recover the interaction between MOR and D2R in the ventral striatum in the morbidly obese. Consequently, the dysfunctional opioid-dopamine interaction in the ventral striatum is likely associated with an obese phenotype and may mediate excessive energy uptake.

Helping a Loved One with Opioid Use Disorder

Recognizing opioid use disorder in a loved one can be challenging. Changes in mood or behavior may be subtle, and denial is common. Some factors raise the risk of opioid use disorder, even before people start taking these drugs. Opioid use disorder also is due to other issues: genes, physical health, mental health and surroundings. It can happen quickly or after many years of opioid use. Anyone who takes opioids is at risk of becoming addicted. People who are addicted to opioids still may hold down jobs and seem stable at work and home. But over time, the opioid use disorder is likely to lead to serious problems.

If you suspect a loved one is struggling with opioid use disorder, it's crucial to:

Seek Professional Help: Talk with their healthcare professional right away.
Express Your Concerns: Don't wait to be asked before you voice your concerns.
Understand the Risks: Be aware that a person addicted to opioids - or any substance - is much more likely to recover if the family doesn't ignore the issue.

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