Questions about the long-term benefits of opioid pain medications are increasing. It’s important that patients understand the basics before beginning treatment, because while opioids provide effective pain relief in the short term, the risk of side effects and long-term impacts like addiction must be taken into account.
How Opioids Work
Opioids provide pain relief by mimicking pain-relieving chemicals that are produced by our bodies naturally. In order for pain signals to reach your brain (and for you to feel pain), the signal must travel through a receptor. Opioid drugs bind to these receptors in your brain and other parts of the body to block your perception of pain. Thus, the cause of the pain does not go away, but you may feel less pain. A common misconception of patients is that opioids will make them pain free.
Prescribing Opioids
While pills are the most common way patients take opioids, they can also be prescribed in the following formulations:
Injection into a muscle
Intravenously through a vein
Patch applied to skin
Suppository placed into the rectum
Spray or patch under the tongue
Pill or capsule that dissolves in the mouth
Nasal inhaler
Different Types of Opioids
The goal of all opioids is pain relief, but they can have different characteristics, such as being short- or long-acting.
Short-acting or immediate-release opioids begin working immediately and will provide peak pain relief in 1 to 2 hours with effects lasting up to 4 hours.
Long-acting or extended-release opioids are released into the body slowly over many hours and the effects may last 12 or 24 hours (some are designed to last days). These formulations provide steady relief over time.
Your doctor will look at your situation and prescribe the regimen that best meets your need. He or she may also prescribe a non-opioid drug in combination with your opioid treatment, or combine a long- and short-acting opioid to meet your pain needs.
Opioid Addiction
In 2014, there were nearly 1.5 times more opioid-related deaths than motor vehicle deaths in the United States. Even when taken as prescribed, people can become addicted to opioids. However, the risks significantly increase when opioids are not taken as directed or are taken in combination with other substances such as alcohol or other drugs with abuse potential.
Everyone has a different risk of addiction and some people are at greater risk than others. If you have a personal or family history of alcoholism or drug abuse, you may have a higher risk of getting addicted to opioids. If you’re concerned about developing an addiction to your opioid medication, talk to your doctor about the best way forward.
When we talk about opioid addiction, it’s important to understand the concepts of opioid tolerance and opioid dependence. Tolerance occurs when chronic users require higher and higher doses over time to achieve the same level of pain relief. While tolerance is not considered addiction, higher doses of opioids are associated with an increased risk of side effects.
Many chronic opioid users develop what we call dependence. That means they experience withdrawal or other negative symptoms if the drug is suddenly stopped. Dependence is a physiological change, rather than the compulsive behavior that defines addiction.
Side Effects of Opioids
All drugs have side effects and opioids are no different. People commonly experience the following when taking opioids:
Blurry vision
Itching
Problems urinating
While many side effects are less bothersome over time, opioid-induced constipation tends to remain a problem and its effects are additive. Often, your doctor will start you on a preventive laxative regimen before you begin taking opioids to alleviate the issue. If they do not you should consider raising the issue with your doctor. If you’re experiencing opioid-induced constipation, you don’t have to live with it—talk to your doctor about treatment options like stool softeners and prescription medicines that can alleviate and prevent your symptoms.
Best Practices for Using Opioids
It’s important to keep in mind that in some states, it’s illegal to drive while taking opioids. Laws are different in every state so you will need to check the laws in your area. You should not operate cars or machinery when starting opioids until your doctor says it is okay to do so, as these drugs impact everyone differently.
Because opioids are controlled substances that have a high risk of being abused, your doctor is likely to ask you to sign a document, often called a pain contract, that outlines risks, expectations, responsibilities, and obligations related to opioid use. This document will:
Make sure you have discussed and tried non-opioid and other therapies such as non-opioid analgesics or adjuvant treatments that may relieve pain but were not necessarily designed for your specific problem
Allow you to only use one pharmacy to fill opioid prescriptions
Allow you to only get prescriptions for opioids from one physician or practice
Explain that increasing doses increases the risk for overdose and other side effects
Explain that opioids are unlikely to totally relieve pain
Detail things to avoid, like alcohol, other mood altering drugs such as benzodiazepines, and all illicit drugs
Clarify that you’re participating in a treatment trial, as opposed to a binding contract for continued use
Direct you to store opioids in a safe place where they cannot be taken accidentally or intentionally by others
Instruct you to never give or sell opioids to anyone else
Mandate testing/monitoring of opioid use
Detail consequences for not following the agreement
