If you need to take opioids to control your pain, here are some ways to make sure you’re taking them as safely as possible. Opioid analgesia is indicated for the management of pain in patients where an opioid analgesic is appropriate. What, exactly, the term appropriate constitutes has been a recently contentious issue. Center for Disease Control and Prevention’s 2016 guidelines for prescribing opioids for chronic pain state that “clinicians should consider opioid therapy only if expected benefits for both pain and function will outweigh risks to the patient.
When using opioids, it should be in combination with nonpharmacologic therapy and nonopioid pharmacologic therapy, as appropriate.” In the same guidelines, the CDC defines the indication of opioid use for acute pain, stating that “when opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three days or less will often be sufficient; more than seven days will rarely be needed.
How Opioids Work
Opioid drugs bind to opioid receptors in the brain, spinal cord, and other areas of the body. They tell your brain you’re not in pain.
They are used to treat moderate to severe pain that may not respond well to other pain medications.
Opioid drugs include:
- Acetaminophen with codeine (Tylenol #2, #3, #4)
- Buprenorphine (Butrans)
- Fentanyl transdermal patches (Duragesic)
- Hydrocodone with acetaminophen (Lortab Elixir, Vicodin)
- Hydrocodone with ibuprofen (Vicoprofen)
- Hydrocodone (Zohydro)
- Hydromorphone (Exalgo)
- Meperidine (Demerol, Merpergan)
- Methadone (Dolophine)
- Morphine and morphine sustained release (MS-Contin, Avinza, Kadian)
- Oxycodone sustained release (OxyContin)
- Oxycodone with acetaminophen (Percocet)
- Oxycodone with aspirin (Percodan)
- Oxycodone with ibuprofen (Combunox)
- Oxymorphone (Opana, Opana ER)
- Pentazocine (Talwin,)
- Propoxyphene with aspirin, propoxyphene with acetaminophen
- Tapentadol (Nucynta, Nucynta ER)
- Tramadol, tramadol with acetaminophen (Ultram, Ultracet)
Table. Opioid Classification
|Mild to Moderate Agonists||Phenanthrenes
|Opioids with Mixed Receptor Actions||Phenanthrenes
Some relative contraindications to opioid analgesics include increased risk of prescription misuse. Several risk factors exist. These include:
Family or personal history of substance abuse
History of legal problems
Frequent contact with high-risk individuals or environments
History of previous problems with employers, family, and friends
History of risk-taking and thrill-seeking behavior
Smoking cigarettes and regularly using other substances that lead to dependence
History of major depression or anxiety
Multiple psychosocial stressors
History of childhood abuse
Previous drug and/or alcohol rehabilitation.
Also, other opioid-specific toxicities exist, which may preclude their use in specific populations. For example, as mentioned above, opioids with serotonergic activity have the potential to lower the seizure threshold, and should, therefore, be used cautiously or avoided entirely in patients with a history of seizure disorder to avoid causing or worsening seizures. Opioids such as methadone, which have the potential to prolong QTc interval should be used cautiously or avoided entirely in patients with Long QT syndrome.
Opioid Side Effects
One of the reasons why your doctor needs to manage pain medications so closely is that they can cause side effects, such as:
- Nausea and vomiting
The drugs lubiprostone (Amitiza), methylnaltrexone (Relistor), naldemedine (Symproic), and naloxegol (Movantik) are approved to treat constipation due to opioid use in those with chronic pain.
Opioids can be dangerous if you take them with alcohol, or with certain drugs such as:
- Some antidepressants and anxiety medications (particularly benzodiazepines such as alprazolam, ativan and clonazpam)
- Some antibiotics
- Sleeping pills
Make sure your doctor knows all of the other medicines you’re taking. That includes:
- Prescription drugs
- Over-the-counter drugs
- Herbal supplements
Opioid Tolerance and Addiction
After taking opioid pain medication for a while, you might find that you need more and more of the drug to achieve the same effect in easing pain. This is called tolerance. It’s not the same as addiction, which involves a compulsive use of a drug.
When you use opioid medication over an extended period of time, you can have dependence. This can happen when your body becomes so used to the drug that if you abruptly stop taking it, you get withdrawal symptoms such as:
- Diarrhea, nausea, and vomiting
- Muscle pain
You can also get a serious addiction to opioid pain medications. People who are addicted compulsively seek out the pain medications. Their behavior usually leads to negative consequences in their personal lives or workplace. They might take someone else’s pills or buy them off the street, which is especially dangerous since those drugs are often laced with lethal amounts of fentanyl. Learn more about what can happen when opioid addiction goes untreated.
If you are having a problem with addiction, you need to see your doctor or an addiction specialist.