Opioids are a type of narcotic pain medication that can be beneficial in specific circumstances of treating pain. Opioids are strong medications prescribed by doctors to block pain signals between the brain and the body (“painkillers”). These medications can be highly addictive and have serious side effects if used incorrectly.
While subtle, there is a significant difference between opioids and opiates.
An opiate is a drug naturally derived from the flowering opium poppy plant. Examples include heroin, morphine, and codeine.
An opioid is a broader term that refers to any substance, natural or synthetic, that binds to the brain’s opioid receptors (portions of the brain responsible for controlling pain, reward, and addictive behaviors). Some examples of synthetic opioids include the prescription painkillers hydrocodone (Vicodin) and oxycodone (OxyContin), as well as fentanyl and methadone.
It is important to point out that while all opiates are opioids, not all opioids are opiates. Also, just because opiates are natural does not mean they are any less harmful. Both opioids and opiates are highly addictive and are often misused.
Because of the way opioids act on the brain, long-term use can lead to physical tolerance, misuse, addiction, and unintentional overdose. In recent years, the use of prescription opioid medications has steadily increased. Opioids are responsible for the majority of overdose deaths in the United States.
However, despite the risks associated with opioid misuse, they are an important option for managing pain. In certain situations, for short periods of time, opioids can offer safe and powerful pain relief.
Opioids can be beneficial for people suffering from severe short-term (acute) pain. They can be useful in treating pain following major surgery or for traumatic injury such as a broken bone. Opioids are used for the shortest possible time, often just a few days. They can also help manage pain for chronic headaches, backaches, and the pain associated with an illness like cancer.
In very select cases, opioids may also be the right choice for people living with chronic, non-cancer pain that hasn’t responded well to other pain medications and affects the patient’s ability to function.
Opioids attach to proteins called opioid receptors on nerve cells in the brain, spinal cord, and other parts of the body. When this happens, the opioids block the pain signals sent from the body through the spinal cord to the brain.
While opioids can effectively relieve pain, the risk of addiction is especially high when opioids are used over a long period of time.
Common Opioid Pain Medications
Although opioids relieve pain, they do not fall into the same category as over-the-counter painkillers such as aspirin and Tylenol. The most commonly used opioids are:
Most opioids are taken in pill form, but they can also be taken as lozenges or lollipops. Some are administered through a vein, by injection or through an IV. Some medications are delivered through a patch (such as Fentanyl) that allows the medication to be absorbed through the skin. There are also opioid medications that can be delivered by suppository.
One of the reasons doctors need to manage opioid pain medications so closely is that they can cause side effects; however, not everyone will suffer side effects while taking them. The most common side effects are usually:
Constipation. Although common, constipation can often be controlled. Opioids slow the movement of stool through the intestinal tract, which allows more time for water to be absorbed by the body and making the stool hard.
Drowsiness. Opioids can make you feel sleepy when you first start taking them, but this usually goes away after a few days. If pain has prevented you from sleeping, you may sleep more for a few days after starting opioids. Opioids can make it unsafe for the patient to drive a car or even to walk up and down stairs alone.
Nausea and vomiting. Some people think they are allergic to opioids if they have nausea after taking them. Nausea and vomiting alone are not usually allergic reactions; however, a rash or itching, along with nausea and vomiting could be. Nausea and vomiting that result from the use of opioids will usually go away after a few days of taking the medicine.
As your body adjusts to the medicine, most of these side effects often go away without treatment. Some people might also experience:
Mental effects (such as nightmares, confusion, and hallucinations).
Slow or shallow breathing.
Patients need to be aware that using opioids can be dangerous if taken with alcohol, or with certain drugs such as:
Because of the side effects, it is essential that your doctor knows of any other medicines you’re taking, including:
Pain Relief with Opioids
If you feel your opioid medication is not helping to control your pain, speak to your doctor. Never change the dosage on your own. If your current dosage is not providing the pain relief you need, your doctor may prescribe a higher dose or change how often you take it.
If changing the dosage doesn’t work, your doctor may prescribe a different drug or add a new drug to the one you’re taking. For longer-lasting pain relief, there are extended-release medicines that come as a pill and a patch that can help control pain for a longer period of time.
If the pain is controlled most of the time, but there are occasional periods of breakthrough pain, doctors can prescribe a fast-acting medicine or immediate-release medication for faster pain relief when it is most needed.
Opioid Tolerance and Addiction
After taking opioid pain medication for a while, you might find that higher doses are necessary to achieve the same amount of pain relief. Your brain and body believe the drug is necessary for survival.
This is called tolerance. Tolerance is not the same as addiction. It is estimated as many as one in four people taking opioids long-term become addicted.
Addiction involves the compulsive use of a drug. People who are addicted compulsively seek out pain medications, which can lead to negative consequences in their personal lives or at work.
Opioids can be a part of an effective pain management plan, but to help avoid side effects and the risk of addiction, it is important to use them only under the supervision of a doctor.
Dependency on a drug can develop over an extended period of time as your body becomes so used to the drug that abruptly stopping it can result in withdrawal symptoms such as:
If you think you might have a problem with addiction or dependence, it is important to talk to your doctor or an addiction specialist.
Should You Take Opioid Pain Medications?
Opioid medications can be an effective therapy as long as you use them safely and follow your doctor’s instructions carefully.
Opioid therapy is a short-term solution for moderate to severe pain that typically cannot be controlled with non-opioid therapies. The use of opioid medications should not exclude other possible long-term treatment options.
Tell your health care provider if you have a personal or family history of substance abuse, as you may be at increased risk of becoming more easily dependent on opioids. Talk to your doctor about side effects, risks, and addiction. Things to look out for include:
Outbursts of temper.
Some safeguards to remember when taking an opioid medication include:
Take them exactly as your doctor prescribes.
Never share your medication with anyone.
Store your medications in a place where children or others cannot access them.
Dispose of your expired, unwanted, and unused medications properly through a local “take-back” or “mail-back” program.
The Novus Spine & Pain Center is in Lakeland, Florida, and specializes in treating chronic pain. By using a comprehensive approach and cutting-edge therapies, we work together with patients to restore function and regain an active lifestyle, while minimizing the need for opiates.