Patient Brochure
A Guide to Staying Safe and Preventing Unintentional Death While Taking Pain Medication
You have received a strong pain medication called an opioid (narcotic). Opioids contain narcotics and are great for treating pain. It is good that you are getting treatment for pain rather than suffering needlessly. But opioids can also harm you if you use them the wrong way. The risk of harm goes hand-in-hand with the benefit of pain relief. The good news is these risks can usually be managed.
Please take a moment to read this guide. It contains information you need to use your pain medication responsibly. This information could save your life or the life of someone you love.
Possible risks from taking opioids include:
- Addiction
- Drug abuse
- Death from overdose
- Disordered breathing during sleep
Who is at risk for addiction?
True addiction to prescription opioids is rare. The rate of addiction to all kinds of opiates is only about 1 percent in the general population and less than 4 percent in patients with chronic pain who take opioids.
Patients who become addicted to opioids will show the following behaviors, known as the 4Cs:
- Impaired control over drug use
- Compulsive use
- Continued use despite physical, mental or social harm
- Craving
Most people who take opioids for pain will not become addicted. Those who do will need treatment for addiction. Addicted people are very susceptible to relapse and may return to active abuse even after being clean for some time. People recovering from active addiction may need several rounds of addiction treatment, and it is important not to give up.
What are some signs of drug abuse and misuse?
So you might ask, if so few people become addicted to opioids, why do so many people seem to be abusing them – or even dying?
Some ways people misuse their medications are by:
- Experimenting with them recreationally
- Sharing prescriptions with others
- Taking too much medication to try to control pain
- Mixing prescriptions with substances such as alcohol, recreational street drugs, or other prescriptions, particularly sedating ones such as Valium
Many young people are especially prone to abusing prescription drugs, perhaps as a result of influence from peers or even because the young tend to need high doses of medication to achieve pain relief. Drug abuse does not discriminate, however, and older people are also in danger of misusing their medications, sometimes to mask feelings of depression, anxiety or other problems.
Stress can contribute to abuse. Unrelieved pain causes stress as do the financial worries and family strain that often accompany ongoing pain.
If stress is overwhelming and opioid use is getting out of control, help is available. Your healthcare provider can supply treatment and coping strategies or refer you to someone who can help.
Any type of opioid misuse can be deadly. Each of us must respect the power of these pain medicines and teach our children to do the same. Just because they have come from a doctor’s office does not make them “safe” when misused.
Why are teens at a higher risk for abuse of prescription pain relievers?
According to the Partnership Attitude Tracking Survey (PATS)*, teens in grades 7 through 12 hold the following attitudes:
- About half of all teens do not see great risk in abusing prescription drugs
- A majority of teens agree prescription drugs are easier to get than illegal drugs
- Fourof 10 believe they are much safer to use than illegal drugs – even if they weren’t prescribed by a doctor
- Roughly three of 10 agree there is nothing wrong with using prescription medicines once in a while and that prescription pain relievers are not addictive
Such surveys show that many teens hold dangerous views about prescription drugs. Furthermore, research shows that most teens obtain the drugs they abuse from family and friends – often stealing prescriptions from a medicine cabinet. It is important to talk to teens about drug abuse and to safeguard your own prescriptions to ensure they are not accessible to teenagers or others who visit your home.
*Completed in 2005 by 7,218 adolescents.
How can you help prevent death from overdose?
If you or a family member is on long-term opioid therapy, be sure everyone in your household knows the danger signs of respiratory depression. Summon medical help immediately if a person demonstrates any of the following signs while on opioids:
- Snores heavily and cannot be awakened
- Has trouble breathing
- Exhibits extreme drowsiness and slow breathing
- Has slow, shallow breathing with little chest movement
- Has a speeded up or slowed heartbeat
- Feels faint, very dizzy, confused or has heart palpitations.
A warning for people who have sleep problems and take opioids.
Sleep apnea is a condition where breathing temporarily stops. It has been observed in up to 75 percent of patients who take opioids long term for chronic pain. Methadone is one opioid tied to sleep apnea in recent research, but other opioids have shown similar effects. When tranquilizers are added, the risk is heightened with some opioids. So far, we have no evidence patients who take opioids short term – such as after a surgery – are at risk. More research is needed, but for now it pays to take a few precautions.
Talk to your doctor if you are being considered for long-term opioid therapy and have been diagnosed with sleep apnea, or have risk factors for sleep apnea such as being overweight or taking a very high opioid dose. Screening methods and treatments for sleep apnea are available.
You should never "play doctor" with opioids.
Never adjust your own doses. Take these medications only as directed and never mix them alcohol or with other sedating substances unless directed by your prescribing physician. Always tell your healthcare provider about all medications you are taking from any source. Keep track of when you take all medications, enlisting the help of others if necessary.
Even when the pain relief from an opioid has worn off, the depressant effect on breathing may continue. This is true for all opioids but particularly true for methadone, which lingers in the body longer than many medications.
It is important to have realistic expectations concerning opioid therapy. A misconception some patients have is that if they are taking opioids, they should experience no pain at all. Opioids provide good pain relief for many short-term and chronic conditions but cannot always be expected to completely remove all pain. Popping more pills than prescribed to try to relieve all pain is dangerous and counterproductive.
Help is available if you need more relief.
If you need more pain relief or suffer from additional symptoms such as insomnia or depression, tell your prescribing clinician. Treatments are available, but a healthcare professional must always supervise the addition of medications, dose adjustments or medication changes.
If opioid use is relieving most of your pain, helping you to live and work more productively and coincides with improved mood and quality of life, it is probably the right treatment. If opioid use is causing your life to spiral out of control, and you are losing function and quality of life, it is probably doing you more harm than good. Know that alternatives are available to treat pain if opioids turn out to be the wrong treatment for you or someone you love.
