Benefits and Risks of Opioid Use in Restless Legs Syndrome: John Winkelman, MD, PhD


The chief of the Sleep Disorders Clinical Research Program at Massachusetts General Hospital discussed the benefits opioids have for patients with restless legs syndrome, as well as how they can be safely used as part of treatment strategies. [WATCH TIME: 4 minutes]

WATCH TIME: 4 minutes

"Our job as doctors is to assess risks and benefits. It’s not to say, ‘I don’t prescribe those medicines,’ [because basically] you’re throwing away your medical license. Always risks and benefits. If you don’t feel comfortable prescribing those medications for personal reasons, you should not be treating patients with augmented RLS. Refer them to someone who has the full stable of potential medications they can use."

In 2021, researchers published an updated algorithm for the management of restless legs syndrome (RLS), with the main change that dopamine agonists should be considered second line, not first, treatments. In addition, the guidelines stated that alpha2-delta calcium channel ligands, and low doses of opioids are effective therapies, but understanding of the mechanisms through which they work will depend on better elucidation of the underlying disease pathogenesis.

The safety concerns with opioids are well known, as they have potential to cause adverse events of drowsiness, mental fog, nausea, and constipation. In addition, they may cause slowed breathing, which can lead to overdose deaths. Despite these risks, opioids can offer significant benefits to patients with RLS, and should be considered as legitimate treatment options, says John Winkelman, MD, PhD. Winkelman, an author on the paper, gave a presentation on RLS to inform the clinical community on these recent recommendations at the 2023 SLEEP Annual Meeting, held June 3-7, in Indianapolis, Indiana.

Following his presentation, Winkelman sat down with NeurologyLive® to discuss effective treatment strategies clinicians should implement for patients with RLS. Winkelman, chief of the Sleep Disorders Clinical Research Program at Massachusetts General Hospital, provided perspective on the need to assess risks and benefits with opioids, why thorough clinical examination is important, and why ignoring potential improvements gained from opioids is a disservice to patients with the condition.

Click here for more coverage of SLEEP 2023.

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