Everything You Need to Know About Opioid Medications

by Christina Lasich, MD Health Professional

Before you start taking a drug, you want to know the answers to important questions like: What is it for? What are the risks? Are there alternatives? Being an informed patient is especially important if you are planning to take the medications for an extended period of time or if there are extensive risks. Typically, opioid drugs like hydrocodone and hydromorphone are used for long periods of time when treating chronic pain. The risks tend to increase the longer these medications are used. If you are planning to start using opioids, get informed with everything you need to know about them first.

What is an opioid drug? An opioid is any chemical that binds to the natural opioid receptor system located in the body. Because this system is within the body, some opioids are produced by the body; thus, they are called endogenous opioids. Examples of endogenous opioids are endorphins, which are produced in the nervous system. Other opioids come from outside the body and are called exogenous opioids. Examples of exogenous opioids include drugs like hydrocodone, codeine, morphine, methadone, oxymorphone, oxycodone, hydromorphone, buprenorphine, and heroin. All of these example are derived from different sources and have different footprints. But all opioids activate the same receptor in the body.

How can opioids be used safely without causing death or addiction? The two major risks of using opioids are death from overdose and “death” from addiction. Quite simply, the best way to prevent these outcomes from occurring is to take the medication as prescribed and only when needed to treat pain. Death from overdose occurs when someone has taken too much of a drug. And a slow “death” from addiction occurs when someone starts abusing the medication by, for example, using it for other reasons besides pain. Even though someone is “not abusing” the drug, this does not mean that person will not become chemically dependent to the drug. Chemical dependency means that the body is so used to taking it that, when stopped suddenly, withdrawal symptoms will occur.

How can I get off opioids now that I am dependent? Once you have been taking opioids for a period of time on a regular basis, your body becomes dependent on the external source of this chemical because the natural endogenous system is shut down. To get off of opioids, gradually tapering from a higher to a lower dose is the most frequently used method. Other methods require medical assistance to manage withdrawal symptoms when the drug is suddenly stopped. However, none of these strategies work without a comprehensive exit plan. Those that have pain need other ways to manage pain without opioids like zero-gravity chairs, home exercise programs, and healthy habits. Those that are struggling with addiction need recovery services to learn new coping strategies, receive counseling, and commitment to lifetime of sobriety. Sometimes stopping opioid medications is a scary but necessary step to a happier, healthier life.

What are some long-term risks of using opioids? Besides previously mentioned risks of death and addiction, some other outcomes can occur when using these drugs for long periods of time. The hormone system can be disrupted. That is particularly true of testosterone. Hypogonadism or low testosterone levels are common in long-term opioid users. Osteoporosis can also occur, partly as a result of the hormonal imbalances. And surprisingly, sometimes opioids can cause more pain because of a condition known as opioid-induced hyperalgesia.

Can your doctor stop prescribing opioids to you? If you signed a contract for taking opioids in a responsible manner and you have violated this contract, then your doctor has every right to stop prescribing opioids to you.

Can someone with a history of substance abuse use opioids? People with a history of abusing other chemicals like alcohol, methamphetamine, marijuana, and benzodiazepines are at high risk of becoming addicted to a different drug. This is called “cross addiction”. The use of opioids in people with this type of history needs to be highly monitored by physicians, loved ones, and sobriety sponsors.

Can anyone become addicted to using opioids? Yes, even those with chronic pain can become addicted and start abusing opioids.

Are there alternatives drugs to opioids for pain relief? Many non-opioid drugs exist to help control pain like muscle relaxants, some anti-depressants, and many anti-convulsants. Consulting with a pain management expert will increase your options for the use of non-opioid drugs.

Christina Lasich, MD
Meet Our Writer
Christina Lasich, MD

Christina Lasich, M.D., wrote about chronic pain and osteoarthritis for HealthCentral. She is physiatrist in Grass Valley, California. She specializes in pain management and spine rehabilitation.