Opioids are prescription medications that relieve severe pain. They work by attaching to specific opioid receptors in the body and blocking pain messages to the brain. Opioids are prescribed for pre- and post-surgery pain, dental pain and injury-related pain among other things. Medications that fall into the class of opioids include codeine, oxycodone and morphine. Drugs such as codeine and diphenoxylate can also be found in other medications used to treat severe diarrhea and coughs.
Opioids are powerful narcotics that have effects similar to heroin and can lead to addiction if not taken properly. The National Institute on Drug Abuse reported that in 2012, about 2.1 million people in the United States suffered from substance abuse related to prescription opioid pain relievers.
“We don’t know how many people become addicted, but we know that it is incredibly likely,” said Dr. Lewis Nelson, a medical toxicologist at NYU Langone Medical Center who specializes in opioid abuse.
Let’s look at some things to watch out for when taking opioid medications and how to ensure that you are taking them safely.
Opioids Have Some Nasty Side Effects
While opioid painkillers may be beneficial at relieving pain, they do come with a number of side effects. All opioids cause constipation because the active ingredients increase the amount of time it takes for food to pass through the gastrointestinal tract. James Patrick Murphy, MD, director of the Murphy Pain Center in Louisville, Kentucky, said that he has seen patients whose bowels have been completely shut down by opioids. To avoid this, it is important to stay hydrated and increase your daily intake of fiber while on prescription painkillers.
Opioids also cause drowsiness. “They’re called narcotics for a reason,” Murphy said. A person taking prescription opioids should refrain from driving or being around fire or sharp objects.
Another thing to watch out for when taking opioids is respiratory depression. Opioids can suppress the breathing mechanism, resulting in hyperventilation if not taken properly. Those taking opioids for chronic pain usually develop a tolerance to respiratory depression and do not have a problem. Nelson said to always take opioids as prescribed and never mix them with alcohol or other drugs.
Opioids Can Be Addictive
Opioids release dopamine, a neurotransmitter that acts on the reward and pleasure system of the brain. “Opiates are very strong stimulants of releasing dopamine in the brain,” Murphy said. This form of gratification can lead to cravings for more of the medication and addiction. Addiction does not occur in all people who take opioids, and it is difficult to determine which population is most at risk.
There are, however, certain patient populations who should take extra care. “The No. 1 risk factor for addiction is someone who has had a problem with opioids in the past or a past addict, or someone with a strong family history of addiction,” Murphy said.
Opioids Are Often Prescribed for the Wrong Types of Pain
Pain is subjective. When a patient visits a doctor’s office and talks about being in severe pain, Nelson said doctors oftentimes prescribe an opioid painkiller. “It’s a calculated risk that we all take,” he said. However, there is a difference between two types of pain: acute versus chronic. Acute pain comes on suddenly and does not last long, while chronic pain persists for months or years and becomes a problem unto itself.
Nelson said the majority of problems with opioids come from people who are taking them for chronic pain. “Chronic pain is not as simple. It is a syndrome onto itself,” he said. If a person is prescribed an opioid for chronic pain, he or she will develop a tolerance to the medication and require higher and higher doses as the pain persists. This could lead to dependence and addiction. A recent study published in the journal Annals of Internal Medicine for a National Institutes of Health Pathways to Prevention Workshop concluded that treating chronic pain with opioids is oftentimes ineffective. “More research is needed to determine who would benefit from long-term opioid use,” said Dr. David Reuben, who was the panel chairman for the workshop. Most studies on opioid use last for 12 weeks or less and there are few follow-up studies. The goals of the workshop were to determine the long-term effectiveness of opioids for the treatment of chronic pain and to review the potential risks of taking opioids in various patient populations. “The workshop was a call to action to come up with much better evidence-based research to show what works and who should be prescribed opioids,” Reuben said.
Reuben said that alternative treatments for chronic pain may include nonsteroidal anti-inflammatory drugs, anti-seizure medication or behavioral techniques.
Opioids Can Be Harmful to a Fetus
New findings from the Centers for Disease Control and Prevention indicate that high rates of opioid painkillers are being prescribed to women of childbearing age, raising fears of birth defects. Researchers analyzed health insurance claims data from 2008 to 2012 for women aged 15 to 44 with either private insurance or Medicaid. They found that 39% of women enrolled in Medicaid and 28% of women with private health insurance filled a prescription for an opioid medication each year.
Dr. Jennifer Lind, a pharmacist at the CDC, said that 50% of pregnancies are unplanned. “A lot of babies could be getting exposed early in pregnancy,” she said. Exposure to opioid painkillers raises the risk of birth defects including spina bifida and congenital heart defects. It also raises the risk of preterm birth and low birth weight.
If you are a woman of childbearing age and concerned about accepting a painkiller prescription from your doctor, Lind suggests asking if there are any treatment alternatives. Another option would be to take a pregnancy test prior to taking the medication. Women can also ask for a lower dose prescription for a shorter amount of time. “CDC is aiming to expand research and develop reliable guidance so women and doctors can make informed decisions,” Lind said. “We want to get prescribers to think that maybe they are treating for two.”