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Opioids are a set of substances including medications, illicit drugs, and more that are derived from opium.

These natural substances are then artificially made and are used in a medical context as medications.

Opioid medications act on the Nervous System to help with pain relief. A prescription is required in all cases of opioid medication use. There is a high risk that there may be an abuse potential with these medications.

However, when used correctly, they can help ease pain, suffering, anxiety, and other symptoms seen in very concerning medical conditions such as Cancer, Broken Bones, Severe Medical issues and complications, and much more.

Abuse potential deals with the OVER use and Over prescribing problems that are seen with medication. Illicit drug use is using street prescriptions/drugs and/or Heroin and other drugs in order to “get high”.

Common Medication examples include:

–  Morphine
–  Oxycodone (Oxycontin, Roxycodone, Percocoet, Roxicet)
–  Hydrocodone  (Lortab, Norco, Vicodin)
–  Hydromorphone  (Dilaudid)
–  Codeine
–  Meperidine (Demerol)
–  Methadone

Additional Information of Medications

1.)  Despite pain treatment, a large concern with opioid medications is that they can lead to opioid dependence.
2.)  Withdrawal syndrome can be seen with abrupt discontinuation.
3.)  Opioids can be used recreationally – which means above the prescription written by a provider and even without a prescription.
4.)  It is believed some 30+ million people, between the ages of 15 and 65, used opiods recreationally in 2013.

Additional Types and Combinations

–  Fentayl – Fentanyl Extended Released Transdermal System
–  Methadone – Methadone hydrochloride tablets or oral solution
–  Morphine Sulfate – Morphine Sulfate Extended Release Capsules or Tablets
–  Butrans – Buprenorphine Transdermal system
–  Dolophine – Methadone Hydrochloride Tablets
–  Duragesic – Fentanyl Transdermal System
–  Exalgo – Hydromorphone Hydrochloride Extended Release Tablets
–  Avinza – Morphine Sulfate Extended Release Capsules
–  Kadian – Morphine Sulfate Extended Release Tablets
–  MS Contin –  Morphine Sulfate Controlled Release Tablets
–  Nucynta ER – Tapentadol Extended Release Oral Tablets
–  Opana ER – Oxymorphone Hydrochloride Extended Released Tablets
–  OxyContin – Oxymorphone Hydrochloride Controlled Release Tablets
–  Embeda – Morphine Sulfate and Naltrexone Extended Release Capsules – (No longer being marketed – but still approved)
–  Palladone – Hydromorphone Hydrochloride Extended Released Tablets – (Voluntary recall – not available or marketed – but still approved)

Method of Action

–  Opioids work by binding to opioid receptors found primarily in the central and peripheral nervous system.
–  They come from the opium poppy.
–  Some are created synthetically – these result in an opium like effect.
–  Therefore – all opiates are opioids but not opioids are opiates.

Medical Uses

1.) Acute Pain

–  Effective for pain following surgery
–  Important in Pallative Care (Complicated medical approach to serious medical issues)
–  Chronic Cancer Pain
–  Degenerative Conditions
–  Rheumatoid Arthritis

2.) Chronic Non-Cancer Pain

–  This is high risk category – risks often greater than benefits in the category.
–  Typically other medications – Tylenol, NSAIDs, and other options prior to opioid categories.
–  The effectiveness of opioids in less complicated neuropathic pains is unclear.
–  Not first line treatment in Headaches
–  Used occasionally in Back Pain
–  Used rarely in Fibromyalgia
–  Non-malignant chronic pain

3.) Shortness of Breath

–  May be Used in advanced cases of COPD [Chronic Obstructive Pulmonary Disease]
–   Used in advanced cases of some cancers with breathing concerns

4.) Diarrhea related conditions

–  Used in some cases of diarrhea-predominate Irritable Bowel Syndrome.
–  Helps with pain but also causes constipation.

Side Effects

–  Drowsiness
–  Euphoria
–  Increased Sleep
–  Mental Confusion
–  Anxiety
–  Respiration Problems
–  Nausea
–  Vomiting
–  Constipation
–  Dry Mouth
–  Itching
–  Restlessness
–  Decreased/Impaired Sex Drive/Function
–  Depression
–  Changes in Menstrual Period
–  Increased Risk for Falls

Tolerance

–  This is a process of Adaptation that results in reduced effectiveness of a drug.
–  Receptor downregulation can occur.
–  Tolerance is not seen in everyone and can vary in severity.
–  Can require a higher dosing to achieve the same benefit.
–  Often seen when use of opioids continues for extended periods.
–  Does not predict future risk for misuse or addiction.

Physical Dependence

–  The Physiological Adaptation to the presence of opioid medication in the system.
–  Can occur with Medications other than Opioids.
–  Withdrawal symptoms occur when substance is discontinued.
–  Can also be seen when the dose is reduced.
–  This is a normal occurrence and doesn’t necessarily mean that addiction is present, but is seen in patients that are addicted.
–  Less likely to have symptoms occur if you slowly reduce opioids over days and weeks if applicable.
–  Treatment of withdrawal can be done with Clonidine

Withdrawal Symptoms

–  Sweating
–  Irritability
–  Nausea
–  Tremor
–  Rhinorrea
–  Myalgia
–  Vomiting

Addiction

–  This is a complex area that includes manipulative actions or words that are associated with the misuse of certain drugs.
–  This is a psychological compulsion that causes the individual to continue actions that can lead to dangerous and unhealthy outcomes.

Misuse of a medication may include but are not limited to the following:

1.)  Amount of medications used
2.)  Obtaining a prescription falsely
3.)  Purchasing pills on the streets
4.)  Stealing prescription medications
5.)  Injecting medications (unless medically advised)
6.)  Crushing medications (unless medically advised)
7.)  Using opioids for purposes other than pain
8.)  Self Harm in order to get medications
9.)  And more.

Interactions

–  Adding Opioids to other medications can come at a risk.
–  Adjustments of medications may be required in some cases.
–  Use of Opioids and Benzodiazepines and/or Alcohol greatly increases the risk and rates of adverse effects, overdoses, and deaths.
–  Use if Sedatives greatly increases risks for breathing problems

Opioid Antagonist

–  These are medications that can reverse side effects or overdose of opiods

Naloxone or Naltrexone

–  Can competitively bind to opioid receptors with a higher affinity but they don’t activate them.
–  It can also displace the Opioid from the receptor.
–  The Half life is shorter so repeat dosing or prolonged infusion may be required

Nalmefene

–  A longer Acting Antagoinist that acts similarly.