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Opioids are extensively utilized therapeutically for management of chest pain during various heart conditions such as, myocardial infarction (MI) and ischemic heart disease (IHD). Emerging literature about the chronic cardiovascular effects of opioid use remains elusive and controversial. While several studies have reinforced the cardioprotective effects of opioid receptor activation in various rodent and animal models, these effects are less established in humans. Other studies have examined the clinical outcomes of opioid use and there is still much division in our understanding. While some of these studies suggest there are no cardiovascular effects, others indicate there are adverse effects including a greater risk for stroke, coronary heart disease and even death. This review paper aims to examine current understandings on the cardiovascular effects of opioids based on experimental and clinical evidence.