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Opioid (Narcotic) Pain Medications

Medically Reviewed by Neha Pathak, MD on August 30, 2021

When you have a mild headache or muscle ache, an over-the-counter pain reliever is usually enough to make you feel better. But if your pain is more severe, your doctor might recommend something stronger: a prescription opioid.

Opioids are a type of narcotic pain medication. They can have serious side effects if you don't use them correctly. For people who have an opioid addiction, their problem often started with a prescription.

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.

How Do 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:

Your doctor can prescribe most of these drugs as a pill. Fentanyl is available in a patch. A patch allows the medication to be absorbed through the skin.

Working With Your Doctor

You'll need a prescription from your doctor before you start taking opioids. The doctor can adjust the dose as needed to help control pain.

You may receive around-the-clock doses to manage pain throughout the day and night. And your doctor may prescribe opioids to be taken "as needed" in case you have "breakthrough" pain -- a flare of pain that you get despite round-the-clock doses.

While you're on opioid pain medications, check in with your doctor regularly. Your doctor will need to know:

  • How your pain is responding to the drug
  • Whether you're having any side effects
  • Whether you have any potential interactions or medical conditions that could make you more likely to have side effects, such as sleep apnea, alcohol use, or kidney problems
  • Whether you're taking the drug properly

Never change or stop taking any opioid medicine without first checking with your doctor. If a pain medication isn't working as well as it should, your doctor may switch you to a different dose -- or add on or try another drug.

When you're ready to stop taking opioids, your doctor may wean you off them slowly -- if you have taken them for a long time -- to give your body time to adjust. Otherwise, you may have withdrawal symptoms.

What Are the Side Effects of Opioids?

One of the reasons why your doctor needs to manage pain medications so closely is that they can cause side effects, such as:

Gastrointestinal problems. You may have nausea and vomiting when you start taking opioids. It often passes after a few days. Try lying down for an hour or so after taking a dose, or ask your doctor for an over-the-counter or prescription nausea remedy.

Constipation is a common problem when you take opioids. They cause food to move more slowly  through your system, which results in harder stools that don’t pass as easily. If you start having trouble:

  • Don’t wait more than 2 days without a bowel movement before getting in touch with your doctor.
  • Drink more water. This alone helps some people with mild constipation. But others may have to do more. Having a hot drink in the morning can get things moving through your GI tract. Avoid drinks with caffeine, like coffee and tea, and instead try hot water with lemon or herbal tea.
  • Ask if other drugs may help. Your doctor may recommend either a stool softener or laxative that you can buy at the drugstore. Other drugs are available by prescription. Lubiprostone (Amitiza), methylnaltrexone (Relistor), naldemedine (Symproic), and naloxegol (Movantik) are approved to treat constipation due to opioid use in those with chronic pain.

Cognitive issues. Some people just don’t feel like themselves when they start taking opioids. You may have:

  • Trouble staying focused
  • Drowsiness
  • “Foggy” feeling or trouble thinking clearly
  • Slow reflexes

Don’t drive or operate heavy machinery while on opioids. It may take a week or more for you to start feeling normal again.

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, clonazepam, and lorazepam)
  • 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
  • Anxiety
  • Irritability

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.

Should You Take Opioid Pain Medications?

Opioids can make a dramatic difference to people with moderate to severe pain, but they aren’t always the right choice. Discuss the necessity of using them with your doctor. If you take them, follow your doctor's instructions carefully. If your pain isn't related to cancer, talk with your doctor regularly about whether you need to keep taking opioids. If you need to continue taking them, lowering the dose or changing the type of opioid may help prevent problems.

WebMD Medical Reference

Sources

 SOURCES:

FDA: "Questions and Answers: FDA approves a Risk Evaluation and Mitigation Strategy (REMS) for Extended-Release and Long-Acting (ER/LA) Opioid Analgesics."

American Cancer Society: "Pain Control."

The Partnership at Drugfree.org: "Prescription Pain Relievers."

American Academy of Family Physicians: "Opioid Addiction."

National Guideline Clearinghouse: "Interagency guideline on opioid dosing for chronic non-cancer pain: an educational aid to improve care and safety with opioid therapy."

National Institutes of Health: "Drug Interactions of Clinical Importance among the Opioids, Methadone and Buprenorphine, and other Frequently Prescribed Medications: A Review."

Medline Plus: "Oxycodone," "Fentanyl," "Hydrocodone," "Hydrocodone Combination Products," "Hydromorphone," "Methadone."

Medscape: “FDA Okays Naldemedine (Symproic) for Opioid Constipation.”

Bill McCarberg, MD, president, American Academy of Pain Medicine.

National Cancer Institute: “Pain Control.”

Leukemia & Lymphoma Society: “Understanding side effects of drug therapy.”

American Chronic Pain Association: “Opioid induced constipation conversation guide.”

American Society of Interventional Pain Physicians: “The American Society of Interventional Pain Physicians fact sheet.”

American Academy of Pain Medicine: “Eight opioid safety principles for patients and caregivers.”

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