Opioids are a set of substances derived from opium.
These 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.
Common examples include:
- Oxycodone (Oxycontin, Roxycodone, Percocoet, Roxicet)
- Hydrocodone (Lortab, Norco, Vicodin)
- Hydromorphone (Dilaudid
- Meperidine (Demerol)
Despite pain treatment, a large concern with opioid medications is that they can lead to opioid dependence.
Withdrawal syndrome can be seen with abrupt discontinuation.
Opioids can be used recreationally – which means above the prescription written by a provider and even without a prescription.
It is believed some 30+ million people, between the ages of 15 and 65, used opiods recreationally in 2013.
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.
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
- Used in advanced cases of COPD [Chronic Obstructive Pulmonary Disease]
- Used in advanced cases of some cancers
- Used in some cases of diarrhea-predominate Irritable Bowel Syndrome.
- Increased Sleep
- Mental Confusion
- Respiration Problems
- Dry Mouth
- Decreased/Impaired Sex Drive/Function
- Changes in Menstrual Period
- Increased Risk for Falls
- 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.
- 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
- 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:
- Amount of medications used
- Obtaining a prescription falsely
- Purchasing pills on the streets
- Stealing prescription medications
- Injecting medications (unless medically advised)
- Crushing medications (unless medically advised)
- Using opioids for purposes other than pain
- Self Harm in order to get medications
- Many more.
- 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
- 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
- A longer Acting Antagoinist that acts similarly.