The continuing problems caused by the opioid epidemic have led to doctors and researchers looking for nonaddictive alternatives to treating chronic or severe pain. One name that has come up is meloxicam, a nonsteroidal anti-inflammatory drug (NSAID) that is used in pain and inflammation therapy. In the quest to come up with safer pharmaceutical options, we take a look at whether meloxicam is dangerous or addictive.
Frequently Asked Questions:
Nonsteroidal anti-inflammatory drugs have many other drugs under their umbrella: ibuprofen, nabumetone, and indomethacin, to name a few. They address problems caused by prostaglandins, chemical compounds in the body that contribute to inflammation in bone joints. The inflammation leads to the recognizable symptoms of pain, such as the swelling and tenderness that sufferers of arthritis are familiar with.
When a patient takes meloxicam, the chemicals in the drug block the enzymes that produce prostaglandins and reduce the overall level of those chemical compounds. This results in a decrease in inflammation and the pain symptoms they cause.
For this reason, meloxicam is prescribed for the treatment of rheumatoid arthritis, osteoarthritis, and juvenile rheumatoid arthritis. The brand-name formulation of meloxicam is Mobic. The drug is administered in capsule, tablet, or liquid forms. The average dose is 5-7.5 mg once a day, with room for adjustment.
As with any other drug, meloxicam has side effects. What sets it apart is that it is a high-dose NSAID, and it can cause significant issues in patients who have heart and gastrointestinal conditions. Some patients are allergic to nonsteroidal anti-inflammatory drugs in general, so taking meloxicam will exacerbate negative reactions, such as being short of breath. As a result of this, people with asthma will be at a higher risk for triggering their allergies if they take meloxicam or any other NSAID.
Patients may also experience hypertension (high blood pressure or an increase thereof) if they have certain health conditions while they take meloxicam, and they might also experience fluid retention and swelling. Patients at risk for heart failure should take meloxicam very carefully, and never without a physician’s approval and supervision.
There is also a danger that meloxicam can impair the ability of the kidneys to function. Due to this, it is dangerous for patients who have kidney problems or who are at risk for kidney failure. Elderly patients, those with heart conditions and liver dysfunction, and patients receiving diuretics, ACE-inhibitors, or angiotensin II antagonists should also avoid meloxicam. Additionally, some patients might develop serious skin ailments like toxic epidermal necrolysis, Stevens-Johnson syndrome, and exfoliative dermatitis., 
Most nonsteroidal anti-inflammatory drugs, like meloxicam, have the potential to increase the risk of potentially deadly heart attacks, strokes, and similar conditions in people who have the risk factors for heart disease, especially in people who are already diagnosed with heart disease. Patients in this situation may be at risk as early as the first week of their meloxicam use, and this threat may increase as use continues. As such, meloxicam should not be prescribed for pain that is the result of coronary artery bypass graft surgery. Additionally, patients taking meloxicam or another NSAID might experience adverse effects to their central nervous system, which includes drowsiness, blurred vision, and dizziness.
Meloxicam has been mentioned as a possible alternative prescription for the treatment of moderate to severe pain instead of opioid painkillers. AP News explains that widespread overprescription of opioid-based painkillers has caused a public health epidemic, one that claims as many as 91 lives every day, with hundreds of thousands more experiencing an overdose.
In response to the issue, doctors and researchers have examined numerous pharmaceutical alternatives to opioids. One of the main stumbling blocks is that pain is difficult to research and measure. Some patients have a higher threshold for pain than others, so an effective pain therapy for one group of patients might have no impact on another. Some drugs have worked well but have induced prohibitive side effects.
Notwithstanding meloxicam’s own side effects, a drug manufacturer is testing a long-acting combination of meloxicam and bupivacaine (an anesthetic) for “notoriously painful operations,” such as hernia repair, bunion removal, and abdominoplasty. Internal studies have suggested that the combination can numb post-surgical wounds by up to three days, and reduce a patient’s need for opioids to manage pain by as much as 50 percent.
Some have suggested that the possible role a nonsteroidal anti-inflammatory drug like meloxicam can play in pain management means that it and other similar drugs can further be used in the treatment of chronic pain. A 2018 study published in JAMA, on the topic of “opioid versus nonopioid medications” in patients who have chronic pain in their backs, knees, or hips found that patients who took opioids for the study did not have better results than patients who were assigned opioid alternatives, like meloxicam. In one year of the study, patients in the opioid group reported slightly higher levels of pain than the patients in the non-opioid group, even though opioids are ostensibly the most potent pharmaceutical painkillers.
A professor at Oregon Health and Science University told Vox magazine that this could potentially mean that opioids will no longer be the go-to medication for the management of moderate to severe pain, and that other drugs – meloxicam being one of them – could pave the way for new ways of addressing chronic pain in patients.
This is encouraging news for those who want to develop pain treatment strategies away from opioids, but does meloxicam present its own addictive risks? As with any drug, it is possible to abuse meloxicam, such as by continuing to take the drug when there is no more therapeutic need for it, or by becoming addicted to the feeling of pain and inflammation being reduced when meloxicam is taken. Physical or psychological dependence on meloxicam is not as severe as that of opioids, but it is nonetheless a concern that a doctor should be on the lookout for in a patient who has displayed the risk factors for substance abuse.
As an NSAID, a patient cannot experience the euphoric high that comes with narcotics and opioids like oxycodone or hydrocodone, but there is still the threat of overdose. A patient who has persistent fatigue, vomiting, and breathing difficulties while taking meloxicam has likely overdosed on the drug and requires immediate medical attention. Taking high doses of meloxicam, or too much of the drug too quickly, will damage the gastrointestinal tract, which can lead to internal bleeding. This is a more likely development of meloxicam abuse than habit-forming psychological highs.
Tragically, because meloxicam is still a prescription painkiller, this has led to some cases of abuse because patients assume that the medication contains opioids. Such is the prevalence of opioids and their abuse, that the term prescription painkiller has become synonymous with the epidemic, even among non-opioid based drugs. This has even led to a small black market for meloxicam. The Department of Justice reported on a seizure of 20 illicit meloxicam pills in New England in 2010, for a street value of $200. The numbers pale in comparison to other substances (11,498 kilograms of marijuana at $40,899,432, for example, or 39,958 OxyContin pills sold for over $2 million), but it does speak to the misperception that since meloxicam is a “prescription painkiller,” it can be abused recreationally.
Even though the addictive potential of meloxicam is virtually nonexistent, the Food and Drug Administration advises doctors against prescribing meloxicam, or its various brand name or generic counterparts, to patients who have demonstrated a risk for developing a psychological dependence on psychoactive medications.
While meloxicam carries little to no risk of being addictive on its own, one danger of abusing the drug is that it might be used in conjunction with other substances. The painkilling properties of meloxicam raise the possibility of the drug being used as the body metabolizes other drugs out of a patient’s system. For example, Mobic is touted as a treatment for hangovers, for people who binge drink and wake up the next day with the usual array of symptoms. Theoretically, meloxicam could alleviate the discomfort of the symptoms. While this will achieve the short-term effect, it does nothing to discourage those dangerous drinking habits, and unnecessary use of meloxicam could still cause internal damage to the body, such as liver failure, given the unhealthy drinking patterns already in effect.
Meloxicam does not alter the brain’s reward pathways the way most drugs do, so it is not considered an addictive drug. People who develop a psychological dependence on Mobic and who discontinue their intake will likely not experience the severity of withdrawal symptoms that come from attempting to quit opioids or alcohol. Nonetheless, people who are in chronic pain or who have serious cases of inflammation and arthritis, and who have been abusing meloxicam to manage that pain, will likely experience an increase in their pain symptoms if they stop their meloxicam consumption. Patients in this situation should immediately consult with their primary care physician about the best way to moderate their meloxicam consumption, so as to not depend on it as much as they did without leaving their pain unmanaged.
Despite meloxicam not being addictive, it is still dangerous; and patients who struggle with their use of Mobic (or its various formulations) should seek medical help immediately to avoid the danger of harming their bodies as a result of excessive exposure to the NSAID. There is also the psychological element that has to be addressed. Even though meloxicam does not have any addictive properties, the abuse of it suggests the presence a substance use disorder, and if that disorder is not treated, then the patient is likely to continue using other, more dangerous, drugs and medications.
Meloxicam and other nonsteroidal anti-inflammatory drugs are unlikely to be as intricately linked with addiction as opioids, but there are still question marks surrounding whether these drugs will offer a way out from the shadow of the prescription overdose epidemic. Psychology Today notes that the risk of gastrointestinal and cardiovascular complications that can arise from the use of NSAIDs mean that while that category of drug is worth talking about as an alternative to opioid prescriptions, doctors should nonetheless be hypervigilant about their patients’ medical histories, risk factors, and the possibility of adverse health reactions when putting people on meloxicam prescriptions.