What Are Opioid Medications?
Table of Contents
Examples of opioids are:
- Oxycodone (OxyContin)
- Fentanyl (Duragesic)
- Hydromorphone (Dilaudid)
Hydrocodone and oxycodone can be prescribed in combination with acetaminophen (Tylenol), which are marketed under the brand names Vicodin and Percocet. Opioids are available in many different forms such as pills, liquids, or suckers. Other methods of administering opioid medications include shot, skin patch, and suppository. While these narcotic pain medications can help in cases of intractable pain, because of their risks of abuse and overdose, they’re not a first-line defense for pain management.
Conditions Associated With Long-Term Opioid UseIt is estimated that one-third of U. S. adults suffer from chronic pain. Chronic pain is the most common reason for long-term opioid use. There are many causes of chronic pain. The following chronic pain conditions may require treatment with long-term opioid use.
1. Low back pain, from many different causes that include:
- Degenerative disc disease (DDD)
- Bulging/protruding disc
- Ruptured/herniated disc
- Vertebral compression fractures
- Spinal stenosis
- Ankylosing spondylitis
2. Hip pain, from many different causes that include:
3. Daily headache. Categories include:
6. Multiple sclerosis (MS)
7. Inflammatory bowel disease:
- Crohn’s disease
- Ulcerative colitis
Do opioids work for chronic pain?
Over the last few decades, opioid medications have been prescribed for the above-listed chronic pain conditions. However, in the last few years, more and more pain clinics and governing agencies are beginning to discourage their use. And this is mainly because more research is showing that they simply don’t work for long-term, chronic pain. As the National Institute on Drug Abuse reports:
“It is not simply an issue of safety. Recent reviews of the science have found surprisingly little evidence supporting the effectiveness of opioids in the treatment of chronic pain conditions (defined as pain lasting longer than 3 months). In some cases, opioids may even contribute to a worsening of pain (hyperalgesia), leading to a vicious cycle of taking more opioids to treat a condition that the medication itself has made less tractable.”
In response, the FDA has also released a comprehensive action plan to reduce the impact of opioid misuse and abuse. And, at PainDoctor.com, we use a 12-step opioid medications protocol to ensure that any patients who do receive opioids are taken off them completely or moved to a lower dosage.
While opioid medications do play a role in pain management, they should only be used in cases when all other treatment options have been exhausted. This is because of the risks of opioid use, abuse, and overdose in addition to their ineffectiveness. Instead, many counsel their use only for acute cases of pain, intractable pain, or as pain relief for those with terminal conditions.
Side Effects And Risks Of Long-Term Opioid UseMost medications have adverse effects and opioids are no different. Opioid medication side effects may include:
- Opioid induced constipation
- Dry mouth
- Constricted pupils (miosis)
- Itching (pruritis)
Other, more serious opioid side effects may include:
- Urinary retention
- Hearing loss
- Respiratory depression
- Hyperalgesia (increased sensitivity to pain)
- Abnormal heartbeats (arrhythmias)
Large doses of opioids can lead to:
- Serious respiratory
- Oxygen deprivation
Other less known adverse effects of long term opioid use include:
- Immunosuppression. Opioids can lead to a diminished immune response.
- Amenorrhea. Opioids can cause hormonal disturbances that culminate in the absence of the female menstrual cycle.
- Galactorrhea. Opioids can cause inappropriate secretion of milk from the breasts.
- Decreased libido. Libido can also be referred to as sex drive.
- Androgen deficiency. Long-term opioid use, especially long-acting opioids, is a key risk factor in the development of hypogonadism, which is characterized by lower than normal levels of the male sex hormone testosterone.
- Osteoporosis. It is characterized by thinning and weakening of bone making it more susceptible to fracture.
Long-term use of opioid medications
Long-term opioid use can also lead to:
Tolerance is an adaptation characterized by the need for increasing or more frequent dosing of an opioid.
Dependence can be physical or psychological. Physical dependence is a scenario in which the abrupt cessation of an opioid results in a withdrawal syndrome. Psychological dependence is an emotional need for a substance that has no underlying physical need.
Although a concern, research has shown that a small percentage of patients with long-term opioid use suffer from addiction. Addiction is characterized by a persistent pattern of dysfunctional opioid use that may include any or all of the following:
- Loss of control over the use of opioids
- Preoccupation with getting opioids, even when adequate pain relief has been achieved
- Continued use despite adverse physical, psychological, or social consequences
- Increased rate of overdose and death
Mental effects of long-term use
Other consequences of long-term opioid use are:
Patients may exhibit aberrant drug-related behaviors such as tampering with doses, taking opioids by alternative routes, seeing doctors to obtain extra opioids, and refilling prescriptions early.
Diversion of opioid medications is a growing concern, but research has shown only a small percentage of those requiring long-term opioid use actually divert their opioids to others. The motivation for diversion is typically money, as mass quantities of opioids can fetch high prices on the black market. As a result, we have seen increasing trends in deaths attributed to opioid abuse.
ConclusionOpioids are a very old class of medications for treating pain. Long-term opioid use is usually associated with a chronic pain condition. In the U.S., one-third of all adults suffer from chronic pain. Most opioids do a nice job of relieving pain, especially the strong opioids who outperformed non-steroidal anti-inflammatory drugs (NSAIDs) and tricyclic antidepressants (TCAs). Adverse effects are commonplace with long-term opioid use and can range from annoying to life-threatening. They are best dealt with in an urgent manner.
Long-term opioid use can suppress the immune system making one more susceptible to infection. Many hormonal imbalances can be triggered by long-term opioid use. Ominous signs in the long-term use of opioids include tolerance, dependence, and addiction. Today, many more deaths are a direct result of the abuse, misuse, and diversion of opioid medications. As a result, interest in abuse-deterrant and tamper-resistant opioid formulations is on the rise and may be a tool against opioid medication abuse.
For more information about opioid medications, or to talk to a pain specialist about other treatment options, click the button below. A certified pain doctor can help you find help from your pain without relying on opioid medications. Or, in extreme cases, they’ll use a combination of therapies to reduce the amount of these narcotic pain medications you need to take.
- Alexander GC, Kruszewski SP, Webster DW. Rethinking opioid prescribing to protect patient safety and public health. JAMA. 2012 Nov 14; 308 (18): 1865-1866.
- Johannes CB, Le TK, Zhou X, Johnston JA, Dworkin RH. The prevalence of chronic pain in United States adults: results of an Internet-based survey. J Pain. 2010; 11 (11): 1230-1239.
- Brush DE. Complications of long-term opioid therapy for management of chronic pain: the paradox of opioid-induced hyperalgesia. J Med Toxicol. 2012 Dec; 8 (4): 387-392.
- Painter JT, Crofford LJ. Chronic opioid use in fibromyalgia syndrome: a clinical review. J Clin Rheumatol. 2013 Mar; 19 (2): 72-77.
- Schneider JP. Rational use of opioid analgesics in chronic musculoskeletal pain. J Musculoskel Med. 2010; 27: 142-148.
- Levin M. Opioids in headache. Headache. 2014; 54 (1): 12-21.
- Furlan AD, Sandoval JA, Mailis-Gagnon A, Tunks E. Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects. Can Med Assoc J. 2006; 174 (11): 1589-1594.
- Brennan MJ. The effect of opioid therapy on endocrine function. Am J Med. 2013 Mar; 126 (3 Suppl 1): S12-8.
- Rubinstein AL, Carpenter DM. Elucidating risk factors for androgen deficiency associated with daily opioid use. Am J Med. 2014 Dec; 127 (12): 1195-1201.
- Rubinstein AL, Carpenter DM, Minkoff JR. Hypogonadism in men with chronic pain linked to the use of long-acting rather than short-acting opioids. J Pain. 2013; 29 (10): 840-845.
- Fishbain DA, Cole B, Lewis J, Rosomoff HL, Rosomoff RS. What percentage of chronic non-malignant pain patients exposed to chronic opioid analgesic therapy develop abuse/addiction and/or aberrant drug-related behaviors? A structured evidence-based review. Pain Med. 2008; 9 (4): 444-459.
- Belcher J et al. Diversion of prescribed opioids by people living with chronic pain: results from an Australian community sample. Drug Alcohol Rev. 2014 Jan; 33 (1): 27-32.