What are opioid analgesics?
Opioid (oh'-pea-oyd) analgesics used to be called narcotics, but today the correct term for these pain medicines is opioids. Opioids are one type of pain medicine; another type is nonopioids, which includes medicines like acetaminophen (such as Tylenol® tablets, caplets, or gelcaps) and ibuprofen (such as Motrin® IB tablets, caplets, or gelcaps). Nonopioids are generally used to treat mild pain, whereas opioid analgesics are used to treat moderate-to-severe pain.
Like all medicines, only the person who is
prescribed opioids should take them. They
should be kept in a safe place where children
and others cannot reach them.
Opioids may be given by mouth, by injection
into the muscle, vein, or spine, or by other
methods. The most common and convenient
way to take opioids is by mouth (known as oral opioids). Most oral opioids are available
as pills; some are available as liquids.
In this brochure, we will discuss the pills.
How long does pain relief from an oral opioid last?
Opioids may be short acting or long acting. Short-acting opioids are sometimes called immediate release. These opioids usually have an effect within an hour and relieve pain for about four hours.
- Short-acting opioids are usually taken when pain lasts only a few days.
- Examples of oral short-acting opioids:
- codeine
(as in Tylenol #3® tablets)
-
hydrocodone
(as in Zydone® tablets or
Vicodin® tablets)
-
hydromorphone
(such as Dilaudid® tablets)
-
morphine
(such as MSIR® tablets or capsules)
-
oxycodone
(as in Percocet® tablets,
Tylox® capsules, or Roxicodone®
tablets or oral solution)
-
propoxyphene
(as in Darvon® capsules or
Darvocet-N® tablets)
- Some short-acting opioid medicines contain the opioid alone, while others contain a combination of an opioid and a nonopioid, often acetaminophen (such as Tylenol® tablets, caplets or gelcaps). For example, oxycodone may be given alone (such as Roxicodone® tablets or oral solution) or in combination with acetaminophen, as in Percocet® tablets.
- When an opioid is combined with acetaminophen,
the total dose of acetaminophen
taken in one day should not be
more than 4000 mg. Higher doses
could damage your liver. People who
have liver disease or drink alcohol
heavily should take even less acetaminophen.
Be aware of how much acetaminophen is in both your prescribed medicine and in the medicine you get without a prescription, such as cold remedies.
Long-acting forms of opioids are sometimes
called controlled-release or extended-release.
This means the medicine is gradually
released into the body over an 8 to 12 hour
period or longer.
- Long-acting forms of opioids are sometimes called controlled release or extended release. This means the medicine is gradually released into the body over an 8- to 12-hour period or longer. Long-acting opioids are usually used for chronic pain that lasts most of the day. They are taken at regularly scheduled times, such as every 12 hours. In addition, a short-acting pain medicine is usually prescribed at the same time, with instructions to take a dose as needed should the pain temporarily increase.
- Examples of oral long-acting opioids:
- morphine
(such as Oramorph® tablets,
MS Contin® tablets, or Avinza® capsules)
- oxycodone
(such as OxyContin® tablets)
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What should I know about opioids and addictions?
You or your family may have questions about
addiction. It is important to understand what
addiction is. Addiction IS a chronic brain disease
that can occur in some people exposed
to certain substances such as alcohol,
cocaine, and opioids. Taking opioids for pain
relief is not addiction. People addicted to opioids
crave the opioid and use it regularly for
reasons other than pain relief.
Addiction IS NOT when a person develops "withdrawal" (such as abdominal cramping or sweating) after the medicine is stopped quickly, or the dose is reduced by a large amount. Your doctor will avoid stopping your
medication suddenly by slowly reducing the
amount of opioid you take before the medicine
is completely stopped. Addiction also
IS NOT what happens when some people
taking opioids need to take a higher dose
after a period of time in order for it to continue
to relieve their pain. This normal "tolerance"
to opioid medications doesn't affect
everyone who takes them and does not, by
itself, imply addiction. If tolerance does
occur, it does not mean you will "run out" of
pain relief. Your dose can be adjusted or
another medicine can be prescribed.
Here are the answers to some questions you may have:
Is it wrong to take opioids for pain?
No. Pain relief is an important medical
reason to take opioids as prescribed
by your doctor. Addicts take opioids
for other reasons, such as unbearable
emotional problems. Taking opioids as
prescribed for pain relief is not addiction.
How can I be sure I'm not addicted?
Addiction to an opioid would mean that
your pain has gone away but you still
take the medicine regularly when you
don't need it for pain, maybe just to
escape from your problems.
Ask yourself: would I want to take this medicine if my pain went away? If you answer no, then you are taking opioids for the right reasons—to relieve your pain and improve your function. You are not addicted.
If I take the opioid now, will it work later when I really need it?
Some patients with chronic pain worry about
this, but it is not a problem.
The dose can be increased or other medicines
can be added.
You won't "run out" of pain relief.
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What can I do about side effects?
Talk to your doctor, nurse, or pharmacist
about the side effects of opioids. If they occur, remember that most opioid side effects
can be treated or prevented.
Constipation
- Constipation from opioids is very common,
but it can be prevented. If it does
occur, it can be treated.
- Prevention is the best approach. If you take opioids daily, then you need to eat more fiber and drink more liquids than you usually do. Many people also need to
take a laxative. The most common type
is a combination of stool softener and
mild stimulant laxative. Those that can
be purchased without a prescription
include Peri-Colace® capsules or syrup
and Senokot-S® tablets. Ask your pharmacist
about less expensive generic
forms.
Nausea or vomiting (upset stomach)
- This does not always occur, but if it
does, it can be treated. Ask your doctor,
nurse, or pharmacist for medicine
to relieve this. After a few days, the
nausea usually stops.
- Try sitting still and breathing slowly
through your mouth.
- Nausea medicines that you can buy
without a prescription include
Dramamine® tablets and Emetrol® oral
solution.
- If your pain is under good control, you
may be able to reduce the nausea by taking
a lower dose of opioid.
Drowsiness (sleepiness)
- Some degree of sleepiness would be
normal when you start taking an opioid,
but after a few days the drowsiness usually
goes away.
- To offset the drowsiness, try beverages
that contain caffeine, such as coffee or
sodas.
- If your pain is under good control, you
may be able to reduce the drowsiness
by taking a lower dose of opioid.
- Be careful. If you feel drowsy, do not
drive a car or operate any dangerous
machinery. Steady yourself when you
walk.
"Slowed breathing"
- The medical term for "slowed breathing"
is "respiratory depression."
- This is very rare when oral opioids are
used appropriately for pain relief.
- If you become so sleepy that you cannot
make yourself stay awake, you may be
in danger of slowed breathing. Stop
taking your opioid and call your doctor
immediately.
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How much and how often should I take my pain medicine?
Keep on top of your pain—don't wait until
pain becomes severe to take your medicine.
Pain is easier to control before it
reaches full force. Set a goal with your
doctor or nurse for pain relief that makes
it easy for you to sleep at night and to do
your daily activities.
Plan a schedule with your doctor or nurse
that provides enough pain medicine to
keep you comfortable and that is timed to
prevent you from becoming uncomfortable
from pain. Only you and your doctor or
nurse can determine the proper dosing
schedule for your pain.
Your doctor or nurse may instruct you to do
some of the following:
- Take the next dose before the last dose wears off. If pain is present most of the day and night, the pain medicine may be taken at regularly scheduled times. If you are taking a short-acting opioid, this usually means taking it every four hours. You may need to set your alarm, especially at night, to be sure you take your dose before the pain returns and wakes you up.
- If your pain comes and goes, take your
pain medicine when pain first begins,
before it becomes severe.
- If you are taking a long-acting opioid, you may only need to take it every 8-to-12 hours, but you may also need to take a short-acting opioid in between for any increase in pain.
- If you take an opioid regularly for longer
than a week, don't suddenly stop taking it.
When your therapy is complete, your doctor
will slowly decrease your dose safely.
If you need to take more or less pain medicine
than planned, contact your doctor to
get the plan changed.
Keeping track of your pain
- Try using the "Pain Control Record" if you have any difficulty getting relief from your pain. This will help you keep track of how well your pain medicines are working and may make it easier to explain problems to your doctor or nurse.
- Use a pain rating scale. Most people use the 0-to-10 scale or the faces scale to rate the intensity of their pain.
- Set a goal for pain relief. Ask yourself what activities you need to do, such as getting out of bed, sleeping, or walking. Then decide what pain rating will make it easy for you to carry out those activities. Everyone is different, but many people need a pain rating of three or less to be able to function well. See completed "Pain Control Record" for an example.
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