Opioids

Opioids

Narcotic analgesics (also known as opioids) have been used to treat moderate to severe pain.

• Most people take opioids for a short time.
• Opioids are often used for nociceptive forms of pain (i.e., acute pain).
  • They are most helpful for specific types of pain:
    • Cancer
    • Terminal illness
    • Severe injury
    • Surgical pain
  • There is less evidence that opioids help chronic pain that is not from cancer.
  • Examples of chronic pain not caused by cancer: low back pain, headache, arthritis.
• A prescription is needed for opioids.
• Healthcare providers must have a special license to prescribe opioids.

How do Opioids work?

While the exact mechanism of action for these drugs is still unknown, we do have some ideas about how they work.

• Opioids cause the brain to release a chemical called dopamine.
• Dopamine regulates the brain's reward system.
• It also influences movement, emotion, thinking, motivation, and feelings of pleasure and calm.
• Dopamine makes it harder for the brain to interpret pain.

We also know that:

• A feeling of euphoria is experienced when this system is overstimulated.
• Opioids also slow breathing.
• Over time, more and more of the drug may be needed to get the same pain reducing effects.

What are the names of some Opioid analgesics?

• Codeine
• Hydrocodone (e.g., zohydro ER, Vicodin, Lortab)
• Oxycodone (e.g., OxyContin, Roxicodone, Percocet)
• Methadone (e.g., Methadose, Diskets, Dolophine)
• Hydromorphone (e.g., Dilaudid, Exalgo)
• Morphine (e.g., Avinza, Kadian, MSIR, MS Contin)
• Fentanyl (e.g., Actiq, Duragesic, Sublimaze)
• Oxymorphone (e.g., Opana)
• Meperidine (e.g., Demerol)
• Tramadol (e.g., Ultram, ultracet, ConZip) – this grouping represents a hybrid class of analgesic

Risks

Opioids have many side effects. The following are common side effects of opioids:

• dry mouth
• itching
• headache
• dizziness
• constipation
• fatigue, sedation, and unclear thinking
• nausea or vomiting
• chest and abdominal pain
• trouble breathing
• mood changes
• abnormal heart beats
• sexual dysfunction
• cardiac arrest
• addiction
• death

The side effects can make it difficult to function.

• People should not drive a car or operate heavy equipment when using opioids.
• Sometimes opioids can also change the central nervous system and make pain feel more intense.

Addiction: Opioids can be highly addictive.

• The addictive properties can lead to misuse and abuse.
• People who are addicted to opioids feel very strong cravings for the drug.
  • They may keep using it even when they see that it causes hurt for themselves or the people around them.
• People who have addiction to opioids are at risk of death, overdose, infections, heart infections, and narcotic bowel syndrome.

Tapering narcotic analgesics

• Please talk to your healthcare provider if you want to reduce your use of opioids.
• It is usually recommended to slowly reduce how much is taken rather than to stop taking it.
• Ideally you and your provider will work together in making the taper a success.

Naloxone: Naloxone (i.e., Narcan), is a medication used to treat overdose.

• It works by reversing the effects of opioids.
• Naloxone can be effective for overdose if it is given in time.
• Pharmacies sell Naloxone.
  • Please ask your pharmacist to show you how to use it.
• Naloxone is available for free at some county health departments.