One of the most frequent reasons people go to the doctor is for pain relief. There are a number of different drugs that can ease pain. About 20% of people will get a medication called an opioid. You could also hear your doctor call it an opiate or a narcotic.
These pain relievers are made from opium, which comes from the poppy plant. Morphine and codeine are the two natural products of opium.
Lab-made versions of morphine produce these other opioids:
It’s always important to take care with prescription medications. But it’s especially important to try to use opioid medications in a safe way because of the risk of abuse and addiction. Several things can help:
- Store opioids in safe place. Try a lockbox if you have kids.
- Never sell or share your prescriptions.
- Check warnings and instructions each time you take a dose.
- Take your medicine exactly as prescribed.
- Never add an extra dose unless your doctor tells you to.
- Don’t chew, crush, break, or dissolve opioid medication.
- Don’t drive or use machinery on opioids. (They make you drowsy.)
- Talk to your doctor about side effects.
- Use the same pharmacy, if possible, for all medicines so they can warn you of interactions that could cause problems.
- Dispose of unused opioids at a drug take-back program or pharmacy mail-back program.
These drugs are generally safe when you take them for a short time as prescribed by your doctor. But in addition to helping you manage the pain, they can also give you a feeling of well-being or euphoria.
And each of those effects could lead you to misuse the drug or take it in a way your doctor didn’t intend. You might:
- Take a higher dose than prescribed
- Take someone else’s prescription, even for a legitimate problem, like pain
- Take it to get high
- Find yourself preoccupied with the drug and when you're next scheduled to take it
It’s a widespread problem. In 2017, approximately 2 million Americans had substance abuse disorders related to opioid medications.
Opioid Use Disorder
For years we used terms like opioid abuse, drug abuse, drug dependence, and drug addiction interchangeably. But the guidelines doctors use to diagnose these issues no longer contain the terms abuse or dependence. Your doctor will look for these symptoms if they think you have opioid use disorder (OUD):
- Using more of the drugs or using them longer than you intended
- Can’t control or cut down use
- Spend lots of time finding drugs or recovering from use
- Have a strong desire or urge to use
- Use despite legal or social problems
- Stop or cut down important activities
- Use while doing something dangerous, like driving
- Use despite physical or mental problems
- Become tolerant -- need more of the drug or need to take it more often
- Have withdrawal -- physical symptoms when you try to stop
Your condition could be:
- Mild: 2-3 symptoms
- Moderate: 4-5 symptoms
- Severe: 6 or more symptoms
If you spot the signs of dependence on the drug or your doctor thinks you have a problem, there is treatment. The first step is to stop taking the drug. Your doctor can slowly lower your dose over a few weeks. You might have symptoms like:
- Craving for the drug
- Rapid breathing
- Runny nose
- Nasal stuffiness
- Muscle aches
- Abdominal cramping
- Enlarged pupils
- Loss of appetite
While they aren't medically dangerous, these symptoms can be painful and hard to live with. The unpleasantness leads to continued drug abuse. In general, the length and harshness of opioid drug withdrawal depends on the drug you are using and the amount you have been taking.
Your doctor can give you medicines to help prevent withdrawal symptoms, a process called detoxification (detox). The most common ones are buprenorphine (Buprenex, Butrans, Probuphine, Suboxone), and methadone (Dolophine, Methadose), and naltrexone (Revia). Lofexidine hydrochloride (Lucemyra) and clonidine are non-opioid drugs that can be used to ease the symptoms during detoxification. Naltrexone can help with detoxification, but it is more commonly used to treat opioid use disorder chronically by blocking your body’s response to opioids. Methadone and buprenorphine are also used long term to help prevent relapse and improve quality of life.
After withdrawal is complete, you’re no longer physically dependent on the drug. But you could still be psychologically hooked. You might be more likely to relapse when you’re under stress or if you’re exposed to other powerful triggers. Learn more about the treatment options available for opioid abuse.
Substance abuse disorder is a chronic illness, which means you’ll have it for the rest of your life. Most people have a relapse at some point. Some people take the medications that help manage withdrawal symptoms, or other drugs like them, for years.
You can also benefit from behavioral therapy. It can help you:
- Manage cravings
- Build healthy habits and thoughts
- Avoid triggers that could lead to relapse
Therapy could be just you as an individual, it could include your entire family, or you could be part of a group with similar issues. It can help you work on relationships and your role at work and in the community.