Opioid Overview
Opioids are a common pain management treatment option for many chronic illnesses or post-surgery recovery.
Some commonly prescribed opioids are codeine, fentanyl, hydrocodone, morphine, and oxycodone. They are available in pill form, and fentanyl is often available as a patch. Opioids reduce pain by binding to pain receptors in your brain, spinal cord, and other areas to block pain signals from reaching those areas. Opioids do not treat the underlying cause of pain but rather reduce pain sensations and improve your quality of life.
Common side effects of taking opioids include:
- Constipation
- Drowsiness
- Nausea
- Vomiting
Prescription opioids are generally a safe, highly effective treatment option for pain relief and management; however, they possess usage risks. Your healthcare professional will further discuss resources and tips to properly manage your opioid treatment and avoid addiction, withdrawal, and overdoses.
Medication Interactions
You should inform your healthcare professional of all medications you take, whether they are over-the-counter pain relievers, prescription medications, vitamins, or other supplements. Opioids can dangerously interact with other medicines such as antidepressants and may result in death or hospitalization. Opioid use may lessen the effectiveness of some antibiotics, and you may not be able to use some over-the-counter cold or flu medications. If you become sick, ask your medical professional what medication you can take.
Do not use alcohol or any other illicit drugs while taking opioids. Doing so increases your risk of potential permanent bodily damage, overdose, or death. Inform your doctor if you are using any other drugs to discuss other treatment options or seeking help to reduce your substance usage.
Addiction
Substance abuse and addiction most often begin with a prescription. According to the Centers for Disease Control and Prevention (CDC), prescription opioid misuse places an estimated $78.5 million economic burden on the United States each year.
About 21-29% of patients prescribed opioids for chronic pain will misuse them, and eight to twelve percent of those prescribed opioids for chronic pain will develop an opioid use disorder. Preventing addiction to prescription opioids is critical for healthcare professionals who prescribe them, and those taking prescription opioids must be aware of signs of addiction.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) establishes the criteria for substance abuse disorders, which include:
- Using the substance in higher doses or for longer periods of time than you should
- Wanting to quit but being unable to
- Spending a large quantity of time getting, using, and recovering from using the substance
- Cravings and urges to use the substance
- Being unable to complete tasks at work, home, or school because of substance use
- Continual usage despite it causing negative ramifications in your work, school, or personal life
- Repeatedly using the substance, even when it places you in danger
- Giving up important social, occupational, or recreational activities because of substance abuse
- Continuing to use the substance despite having another medical condition that the substance can exacerbate
- Increased tolerance to the substance, which leads to needing more of the substance to get the desired effect
- Developing withdrawal symptoms
These addiction criteria often present themselves in three main categories that can easily be remembered by the “Three C’s:”
Control: Patient has lost control and will try to obtain more opioids because they consumed their allotted amount too quickly by engaging in activities such as:
- Reporting lost or stolen medication
- Calling for early refills
- Obtaining opioids from other sources
- This may include illegal drug trade
- Presenting withdrawal symptoms
Craving: Patient remains focused on opioids as their only treatment option by engaging in behaviors such as:
- Recurring requests for more opioids – sometimes more of the same opioid they already take or by asking for different opioids
- Reporting increased sensations of pain or frequency of pain despite no progression of their medical condition
- Dismissive of non-opioid based treatments
Consequences of use: Patients continually engage in the aforementioned activities despite any negative consequences or risks associated with their actions.
The symptoms and behaviors associated with addiction and substance abuse disorders vary from person to person. Some may only show some of the eleven criteria for addiction and substance abuse, while others will show all of them.
Withdrawal
Withdrawal occurs when someone stops using a substance or lowers their dosage. While some withdrawal symptoms can be normal as you slowly taper off your prescription opioid use, withdrawal can be dangerous.
Withdrawal symptoms include:
- Abdominal pain
- Anxiety
- Craving for the drug you’ve stopped using
- Diarrhea
- Insomnia
- Irritability
- Muscle pain
- Nausea
- Tremors
- Vomiting
Your medical professional will instruct you on how to taper off opioids slowly to avoid withdrawal symptoms. Some symptoms are common, but there are medications that help alleviate some of them.
Overdose
A drug overdose occurs when someone takes more than the recommended amount of a drug. From 1999 to 2014, overdoses caused by opioid pain medication claimed over 165,000 lives in the United States. Signs of an overdose include:
- Slow, shallow breathing
- Extreme sleepiness
- Inability to talk
- Blue skin color and dark-colored lips
- Unresponsive
- Snoring or gurgling sounds
If someone exhibits these symptoms, call 911 or your local medical emergency line immediately. Do not leave the person overdosing alone. Perform CPR if necessary, and administer naloxone if you have any on hand. Naloxone is more commonly known as Narcan and is an opioid antagonist that rapidly reverses opioid-induced overdoses.
What To Expect From Your Medical Professional
Your doctor will administer a treatment program designed to prevent addiction that will include:
- A limited supply of prescription opioids that may or may not include a refill option
- Create a tapering off plan to help patients avoid withdrawal symptoms
- Require step therapy before prescribing: Step therapy requires patients to try several different treatment options and fail before moving on to treatment options such as opioids or surgery
While addiction and substance abuse cannot always be completely prevented, you can help reduce your chances of abusing your prescription opioids by:
- Having a caregiver administer opioids or supervise your use of opioids to ensure you are not misusing them
- Use time-release medication caps that prevent you from taking more medication until the timer expires
Because of prescription opioids’ addictive nature, you should always properly store and dispose of unused opioids. Store your prescription in a safe and secure place where others cannot access them. Do not share your prescription with anyone. If you must dispose of any unused opioids, follow proper disposal protocol, which you can typically find on the drug information sheet provided by your pharmacy. Some pharmacies or police departments hold prescription medical collections where patients can bring their unused or expired prescription medication.
