Opioid use and safety

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Opioids are medicines used to treat moderate to severe pain. They may not take away all the pain, but they can make you feel more comfortable.

Taking opioids correctly

Taking your medication correctly — as prescribed by your doctor — can prevent side effects and complications from opioids.

  • Never take more opioid medicine than has been prescribed.
  • Don't drink beer, wine, or other alcohol while taking opioids.
  • Don't take opioids with other drugs (prescription, over-the-counter, herbs, etc.) before talking to your doctor or pharmacist.
  • Never take medications that were not prescribed to you, including "street" drugs.
  • Don't chew, crush, or dissolve pills, unless instructed to by your doctor or pharmacist.
  • Don't fold, cut, or place heat over opioid patches.

Practice opioid safety to protect yourself and others.

  • Carefully read the information that comes with your opioid prescription.
  • Check the prescription label to make sure it's the right medicine and the correct dose.
  • Don't drive until you know how your medication will affect you.
  • Learn the signs of overmedication or overdose.
  • Never share or sell your medications.
  • Store opioids in a locked drawer, cabinet, or box to keep others from using it.
  • Safely throw away unused medications.

Side effects of opioids

Side effects of opioids can include:

Additional side effects to consider when taking opioids long-term include:

  • osteoporosis
  • decreased sexual desire and performance due to lowered testosterone levels
  • increased pain sensitivity (hyperalgesia)
  • sleep apnea
  • other chronic conditions

When to call a doctor or 911

Call a doctor immediately if you have any of these signs of overmedication:

  • difficulty waking up
  • feeling very dizzy or faint
  • feeling very drowsy or falling asleep
  • intoxicated behavior ("acting drunk")
  • unusual snoring or gasping during sleep

If you think you may be overmedicated, stop taking your opioid medication and call your doctor immediately. Stay awake and move around. Do not go to sleep.

Make sure friends, family, and coworkers know the warning signs of overdose. They should call 911 immediately if you have any of these reactions:

  • blue or purple fingernails or lips
  • cannot wake up
  • gurgling sounds coming from the mouth
  • limp body
  • slow or stopped heartbeat
  • trouble breathing

If you feel like your medicine isn't working to reduce your pain, talk with your doctor. Never take more medicine, or use it more often, than your doctor prescribed.

Short-acting opioids

If your pain comes and goes, your doctor may prescribe short-acting opioids. These medications work fast to relieve pain and can help you feel better for a few hours.
Common short-acting opioids include: 

Long-acting opioids

These medicines take more time to work but the pain relief lasts longer. They are usually taken around the clock, rather than as needed. You may also hear them called "extended," "controlled," or "sustained" release medications.

Long-acting opioids include:

Opioids with acetaminophen

Many opioid medications are combined with acetaminophen (Tylenol). Follow these guidelines to avoid liver damage caused by acetaminophen overdose:

  • Never take more than you've been prescribed.
  • Never take opioids with other medicines containing acetaminophen.
  • Do not take more than 1,000mg per dose, or more than 4,000 mg of acetaminophen per day unless directed by your doctor
  • If you are over 75 years old, do not take more than 3,000mg per day.
  • If you have liver problems or drink more than 1 alcoholic beverage per day, take no more than 2,000mg per day.

Symptoms of too much acetaminophen include:

  • loss of appetite
  • nausea
  • vomiting
  • abdominal pain or discomfort
  • confusion
  • yellowing of the skin and eyes

Can I become addicted to opioids?

Addiction to opioids is rare when you take your medication correctly, but the risk may increase with long-term use.

If you are worried about addiction, talk to your doctor, nurse, or pharmacist. If you have had (or currently have) problems with substance abuse, be honest with your doctor. Your pain can still be treated.

Even if you are not addicted to opioids, you may have withdrawal symptoms if you stop taking the medication, including:

  • cold flashes with goose bumps
  • diarrhea
  • insomnia
  • leg movements you can't control
  • muscle and bone pain
  • restlessness
  • vomiting

To stop taking opioids safely, slowly take less medication over time (as directed by your doctor). Talk to your doctor before stopping any medication.

Long-term use of opioids

Long-term opioid therapy is usually prescribed for people who:

  • don't see pain improvement with other types of treatment alone
  • have had success and improved function with short-term opioid use
  • also use complementary treatments, such as physical or behavioral therapy

If you are using opioids for a long period of time (over 6 months) your doctor may help you create an opioid therapy plan where you:

  • sign a medication agreement to help you understand your responsibilities when taking opioids
  • set pain management goals for treatment
  • agree on expectations for pain relief with medications
  • regularly evaluate how effective your treatment is
  • identify some things you can do at home to ease pain

Opioids in older adults

If you are over 65, you may be able to use a lower dosage of medication. Long-term effects on seniors include kidney and liver damage, increased confusion, and risk of falls.

Pregnant women

While long-term use of opioids doesn't appear to cause birth defects, it can affect your baby — both while you are pregnant, and while you are breastfeeding.

Talk to your doctor about the risks and benefits.

Sources:

Opioids911

National Institute on Drug Abuse

Reviewed by: Andrew Bertagnolli, PhD, November, 2015

Additional Kaiser Permanente reviewers

©2015 Kaiser Permanente

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