Dr. Aragona Giuseppe
For millions of Americans, opioids have significantly decreased pain and helped them return to normal lives. While opioids can be extremely effective in pain management, they also can be highly addictive and are often misused. Between 1999 and 2018, more than 232,000 Americans died from overdosing on prescription opioids.
Finding help for your pain shouldn’t have to mean an increased risk of becoming addicted or facing an overdose. This guide provides answers about common opioid questions, offers alternative therapies for pain management, and includes answers from a medical professional.
If you or someone you know needs help for an addition immediately, reach out the National Helpline provided by the Substance Abuse and Mental Health Services Administration.
How Are People Managing Pain with Opioids?
Opioid prescriptions rose significantly in the 1990s, but substance abuse and addiction issues have caused the medical community to rethink prescribing drugs classified as opioids – especially for long-term pain management.
What Are Opioids?
Much confusion exists around what constitutes an opioid. At its most basic form, an opiate is a type of drug produced naturally by the opium poppy plant. Laboratories also make synthetic versions. The properties of the opium flower provide pain relief by blocking signals sent by the brain to the body.
Several types of opiates exist in both legal and illegal forms. All are considered narcotics, meaning this class of drug is known to dull the senses and relieve pain. Some of the ones you may be familiar with include:
While many doctors prescribe opiates to help with a variety of chronic pain due to illness and injury, each comes with a level of risk. When these drugs are taken daily, our bodies have a tendency to build up a tolerance. Because of this, opioids become less effective in producing the desired effect and can result in the need for higher doses. When this happens, individuals are at an increased risk for developing an addiction and/or overdosing.
Opioids also come with significant side effects, including opioid use disorder, depression, respiratory depression, mental confusion, hallucinations, and nausea, among others. If other health conditions are present – or other medicines/substances are regularly used – other risks must also be considered. These include issues with your liver, kidneys, and respiratory system.
Who Needs Medically Supervised Pain Management?
Doctors prescribe opioids for a variety of ailments and injuries, but even when used under the supervision of a medical professional they still come with serious risks. Ideally, opioids should only be prescribed to manage short-term pain resulting in surgeries, broken bones, or other acute issues. When an oral surgeon prescribes an opiate to help with pain after removing wisdom teeth, the drug is only meant to be taken while active pain persists.
Over the last several decades, however, the prescription of opioids has skyrocketed. Pharmaceutical organizations began peddling opioids to prescribing doctors with the assurance that these types of pain relievers were non-addictive. In reality, opioids are highly addictive. Deaths related to opioids first began to rise in the early 1990s; since that time, the numbers have only continued to increase. In 2018 alone, more than 47,000 people died from opioid overdoses – up from 42,000 in 2016. An additional 10.3 million people misused prescription opioids in 2018 and two million Americans faced an opioid use disorder.
The reality is that the vast majority of individuals experiencing pain do not need to be prescribed opioids – especially those with long-term pain issues. Other options exist, but it’s important to find a doctor who is open to exploring alternative pain management treatment plans.
If You Have Been Prescribed Opioids
If prescribed opioids, you should speak with your doctor to ensure you understand risk factors and have a pain management plan in place to mitigate any unforeseen challenges.
When first visiting a doctor, pay close attention to their approach to pain management. “A patient should be concerned if an opioid is the first course of action, especially if they have a new pain or if it’s not classed as severe,” says Dr. Aragona Giuseppe. “Other pain management methods should be tried before resorting to opioids due to their additive nature.”
True or False: Proper Use of Opioids
It’s okay to mix opioids with alcohol.
FALSE: drinking alcohol while taking an opioid increases the risk of life-threatening complications, including respiratory depression and overdosing.
If I feel like the medicine isn’t having the desired effect, I can take another tablet
FALSE: individuals should only take medicine as prescribed and never take more than their doctor directs. If you feel your pain isn’t properly managed, talk to your doctor.
I should tell my doctor about any other medications I am taking.
TRUE: opioids can react with many other types of drugs, especially antibiotics and those used for anxiety/depression. Tell your doctor about any other medication you take, whether prescribed or not.
Opioids are highly addictive and should only be prescribed for short amounts of time.
TRUE: Opioids should only be used for short-term pain management. Otherwise our bodies adjust to the prescription and require higher doses over time which can result in addictions and/or overdoses.
Buying drugs from others is safe so long as I know the person.
FALSE: The Drug Enforcement Administration has seen an uptick in fake drugs laced with fentanyl, resulting in thousands of accidental deaths.
FAQ: Safety When Taking Opioids
Because opioids carry multiple risk factors, it’s imperative that you take them properly and as prescribed. A few things to keep in mind if you receive an opioid prescription:
Review all printed materials
In addition to reading all directions and information about how to safely take your new prescription, you should also ensure the label on the front is correct and follow the dosage information on how much to take and when to take it.
Only take with approved substances
Opioids interact with many other substances, making it imperative that your doctor knows what else you take/use. You should avoid any type of alcohol or any other medications not approved by your physician while taking an opioid.
See how the medicine affects you
Some individuals may experience side effects such as sleepiness, dizziness, blurred vision, or nausea when taking an opioid. Because of this, it’s important to see how you respond before driving or operating machinery.
Only take your medication
Do not take medication from anyone else and do not give or sell your medication to another person. If your medication expires, throw it away or drop it off at a recognized medication disposal box.
Pain Management Plans
Pain management plans are made in consultation with your doctor. These typically include the goals of your treatment, suggested pain management therapies, and plans for how your care team to work together. Creating a plan at the beginning of your treatment ensures awareness from all parties about how opioids should be used. For instance, if your doctor decides that an opioid prescription should only be used on a short-term basis, the pain management plan should spell this out so everyone is on the same page. Be sure to ask your care provider about creating a plan before you begin taking a new prescription.
If You’ve Had Trouble with Opioids in the Past
Because opioids are so addictive, many people may have struggled with an opioid dependency, allergy, or other issue in the past. If this is the case, your doctor should work with you to find an alternative yet effective treatment. A few steps you should take in this situation include:
Go see a doctor
Managing severe pain on your own is ineffective and can lead to a relapse.
Ask about different pain management options
Stay on top of your pain
Ask for second opinions
Recognizing Prescription Opioid Abuse
Even when taking a legally prescribed opioid, you can still develop an opioid abuse disorder. If this happens to you or someone you know, contact the Substance Abuse and Mental Health Service Administration’s National Helpline.
Warning Signs of Opioid Abuse
Opioid abuse can manifest in myriad physical, emotional, and behavioral ways. Whether you recognize these in yourself or a loved one, symptoms such as those listed below should not be ignored.
Sudden changes in appetite or weight loss are common in those experiencing opioid abuse. It is also common for individuals to experience uncontrollable cravings and gain weight.
Failure to keep up with bills and other financial responsibilities, or stealing from friends, family members, or businesses, can signal financial irresponsibility due to opioid abuse.
Many individuals struggling with opioid abuse withdraw from those they know and love, both out of shame and a desire to be alone.
Changes in sexual desire
Misuse and overuse of opioids can create changes in sexual desire, specifically a decreased libido.
Altered sleep habits
Staying awake for hours on end or sleeping outside standard rest times can both signal issues at hand.
Because opioids are known to dull the senses, individuals abusing one of these substances may seem extra drowsy.
Disciplinary measures, unsatisfactory work products, and trouble arriving to work on time can all mean the individual is experiencing problems around controlling their opioid use.
What to Do if You Suspect Opioid Addiction
If you suspect that you or someone you know or love is struggling with an opioid dependence, there are several things you can do.
Keep Naloxone on hand
Also known as Narcan, this medication is used during an overdose to prevent death or respiratory depression. Have one in your home just in case.
Remove the stigma
People struggling with addiction issues must decide for themselves to seek help if any treatment protocol is going to work effectively. Part of motivating someone to get help is to ensure they understand that shame and embarrassment should not be part of their thought process.
Without sounding accusatory, try to compassionately let the person know that the addictive actions – rather than the person – affect others and you want to help them get better.
Getting Help for Addiction
Once you or someone you know acknowledge an overdependence or addiction to opioids, it’s important to know that plenty of options exist for getting help. These include:
Abstinence-based programs help patients slowly wean off the drug and address any health issues that crop up during that time. No medication is used in this approach outside the weaning drug.
Medication-assisted treatment (MAT)
MAT programs provide medications that help reduce cravings for the drug while also dropping the dosage over time.
Both detox and MAT programs are available at patient and outpatient programs, with timelines varying based on individual patient needs. These should also include some type of counseling or therapy to help the person address any underlying mental health concerns related to the drug. Individuals can also attend meetings such as Narcotics Anonymous to find community and support.
If you or someone you love is struggling with addiction, don’t be afraid to ask for help. Reach out to the Substance Abuse and Mental Health Services Administration’s National Helpline.
Pain Management Alternatives to Opioids
Myriad pain management alternatives exist for patients who feel unsure about taking opioids or those whose pain may be better managed by a different type of medication. Some of the most common options include the following:
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Common types of NSAIDs include ibuprofen, aspirin, naproxen, celecoxib, and indomethacin. These drugs fight against substances in the body associated with fever, pain, and inflammation. They are non-habit forming.
FAQ: Over the Counter Medications
Can you “stack” over-the-counter medications with opioids so you don’t have to take opioids as often?
Before taking any additional medication when prescribed an opioid, it’s imperative that you speak to your doctor. Certain medications have interactions that can lead to serious complications. Your doctor should ask about any prescription or over-the-counter medications you take currently or intermittently. If not, be sure to bring it up and ask.
Can you take too much Motrin?
Is acetaminophen safe?
Yes. Also known as Tylenol, acetaminophen is considered one of the safest over-the-counter medications for pain management. That being said, it must be taken safely and within reason. Because acetaminophen is found in cold, flu, allergy, and sleep medications, individuals can easily accidentally overdose. A UC San Diego pharmacist noted that 30-50% of acetaminophen hospitalizations are due to unintentional overdoses. If you consistently take more than recommended, it can cause liver damage over time.
Cannabis for Pain Management
The use of medicinal marijuana, both in THC and CBD forms, has risen in recent years for pain management. While ongoing research continues, a report out of Canada found that taking three hits of cannabis per day reduced pain in patients with chronic nerve pain and increased sleep. In all but nine states, marijuana is either fully legal or available for medicinal use. If unsure whether cannabis could help manage your pain, consider speaking to your doctor about options.
Your Pain Management Questions Answered by a Doctor
Dr. Aragona Giuseppe is a General Practitioner and medical advisor at Prescription Doctor. Prescription Doctor connects healthcare professionals with patients via private and discrete online appointments.
How do you see the field of pain management evolving in the coming years?
With the opioid over-prescription being highlighted, this will encourage Doctors to reconsider before prescription and gradually we should see the medical field make the switch to trying alternatives before reaching for opioid pain medication.
Advancements in healthcare, including consumer medical devices and online services, will make it easier for those in need of pain management to gain access to treatments. This happens in many other fields – not just healthcare.
What advice do you have for individuals with chronic pain who want to avoid opiates for fear of addiction?
What advice would you give to someone who wants to explore alternative options but isn’t sure where to begin?
Resources for Pain Management Support and Opioid Information
- Comprehensive Pain Rehabilitation Center
The Mayo Clinic offers a three-week outpatient program designed to help patients with chronic pain find answers and get on with their lives.
- The Echo Project
This innovative telehealth pain management program, organized by the University of New Mexico, allows practitioners from across the country to get assistance on unique cases.
- Guideline for Prescribing Opioids for Chronic Pain
The Centers for Disease Control and Prevention created this guide to specifically offer recommendations on the use of opioids in treating chronic pain.
- Medical Cannabis and Pain Management
This paper in the Journal of Applied Laboratory Medicine investigates how marijuana can be used in treating pain.
- Non-Opioid Treatment for Pain Management
The American Society of Anesthesiologists looks at alternative medications that can help manage pain.
- Opioid Use and Safety
Readers can find actionable information on how to responsibly take opioids from Kaiser Permanente.
This nonprofit organization offers several resources and tips on pain management in a variety of patients.
- Pain Management Best Practices
The Interagency Pain Research Coordinating Committee, as part of the National Institutes of Health, created a report on acute and chronic pain management.
- Rural Opioid Technical Assistance
The Substance Abuse and Mental Health Services Administration developed this program to help rural communities address the opioid crisis.
- Safe and Responsible Use of Opioids for Chronic Pain
The U.S. Department of Veterans Affairs offers this accessible patient information guide for individuals wanting to learn more.