Opioids
What are Opioids?
Narcotic analgesics (also known as opioids) have been used to treat moderate to severe pain. Most individuals take narcotic analgesics for short periods of time mostly for nociceptive forms of pain (e.g., acute pain). Narcotic analgesics have been used to treat pain associated with cancer, terminal illness, severe injury, and post-surgical pain. There is less evidence that narcotic analgesics are effective in treating chronic non-cancerous forms of pain (e.g., low back pain, headache, arthritis) even though these forms of chronic pain can be quite intense. Narcotic analgesics require a prescription and a physician must have a special license to prescribe opioids.
How do Opioids work?
While the exact mechanism of action for these drugs is still unknown, we do have some idea about how they work.
Opioids cause the brain to release a chemical called dopamine. Dopamine regulates the brain's reward system and influences movement, emotion, thinking, motivation, and feelings of pleasure and calm. It also raises the threshold for pain by making it harder for nociceptive information to be interpreted as pain by the brain. Overstimulation of this reward system is associated with feelings of euphoria and slowed breathing. Over time, more and more of the drug may be needed in order to get the same pain reducing effects.
What are the names of some Opioid analgesics?
- Codeine
- Hydrocodone (e.g., zohydro ER, Vicodin, Lortab)
- Oxycodone (e.g., OxyContin, Roxicodone, Percocet)
- Methadone (e.g., Methadose, Diskets, Dolophine)
- Hydromorphone (e.g., Dilaudid, Exalgo)
- Morphine (e.g., Avinza, Kadian, MSIR, MS Contin)
- Fentanyl (e.g., Actiq, Duragesic Sublimaze)
- Oxymorphone (e.g., Opana)
- Meperidine (e.g., Demerol)
- Tramadol (e.g., Ultram, ultracet, ConZip) – this grouping represents a hybrid class of analgesic
Risks
Side effects: The side effects of narcotic analgesics can include the following: dry mouth, itching, headache, dizziness, constipation, sedation, vomiting, chest and abdominal pain, nausea, fatigue, unclear thinking, headache, trouble breathing, mood changes, abnormal heart beats, sexual dysfunction, cardiac arrest, addiction, and death. Narcotic analgesics also interfere with productive functioning such as driving a car, operating machinery, and performing many work-related tasks. Sometimes opioids can also modify the central nervous system such that the perception of pain actually gets amplified rather than reduced.
Addiction: Opioids can be highly addictive which can lead to misuse and abuse. Addiction is characterized by overwhelming cravings for the drug, compulsive use of the drug, and continued use of the drug even after evidence of harm to one's self or others being associated with the use. Addition to opioids has been associated with the following risk factors: death, overdose, infections, heart infections, narcotic bowel syndrome.
Tapering narcotic analgesics: If reducing the use of narcotic analgesics is desired, it is recommended that you consult with your healthcare provider. Usually the taper will involve a slow controlled reduction in the amount and frequency of drug use. Ideally you and your provider will work together in making the taper a success.
Naloxone: Naloxone (i.e., Narcan), is a medication that can reverse the effects of opioids and can be quite useful in situations where there has been an overdose.
