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Opioids

Opioids. Just saying the word makes people uncomfortable. And for caregivers and their loved ones who are dealing with pain, there is an added anxiety based upon the current publicity regarding opioid medications. Having a basic understanding of opioids, what they are and how they are used, may help alleviate some of the stress.

Opioids are defined as any of various sedative narcotics containing opium or one or more of its natural or synthetic derivatives. These substances act on receptors in the brain, the spinal column and gastrointestinal tract to produce morphine-like effects. They block or reduce the pain messages from the source of the pain to the brain. When the pain is blocked, breathing slows down and there is an overall calming effect.

Opioids are the first line of therapy for cancer pain.

Opioid Pain Medications

The three main categories of opioids are:

Natural

These contain the rosin of the opium poppy.

  • codeine
  • morphine

Semi – synthetic

These are created from natural opiates. The most recognized forms are:

  • oxycodone (OxyContin, Percocet, Percodan)
  • hydrocodone (Vicodin)
  • hydromorphone (Dilaudid)

Synthetic

These are man-made products.

  • fentanyl
  • methadone

Forms

Opioids may be given in a variety of forms.

  • Intravenously or by injection
  • Liquid form
  • In tablet form
    • Immediate release – Taken for continuous or abrupt onset of pain.
    • Extended release – These pills are taken less frequently because the medication is released slowly into the blood stream maintaining a constant level, smoothing out the “bolus effect” of peak (highs) and trough (lows) extremes.
  • Patch – The medication is absorbed through the skin over an extended period of time allowing pain relief for up to 72 hours.
  • Sublingually – This form is used as a rescue medication. It is absorbed through the mucus membranes of the mouth providing immediate pain relief.

Aspirin or acetaminophen are pain relievers (analgesics) that are added to some opioids (semi-synthetics) to aid in relieving pain.

Common problems associated with opioid medications

As with any other medication, opioids can have side effects. They include:

Constipation

Can happen even on the smallest dose of an opioid medication. As long as the opioid medication continues any regimen you establish must be consistent to limit the effects of constipation.

Sedation

Opioids put users to sleep, and at the very least, makes them drowsy when first taken. But as the body gets used to the dosage that effect subsides after a few days.

Nausea and vomiting

May occur when first taking opioids but usually goes away after a few days. If it continues an anti-nausea medication can be prescribed.

Dry mouth

This problem requires good oral hygiene, brushing and flossing after eating, to keep it under control. Saliva replacements or stimulants are available over-the-counter (Biotene).

Histamine release

An oral antihistamine may be given if itching (pruritus) and hives (urticarial) develop or if difficulty breathing (broncoconstriction) occurs.

Toxicity or delirium

Agitations, hallucinations, confusion, vivid dreams and sudden muscle twitches and jerks (myoclonic) are symptoms of toxicity.

Addiction

The psychological and behavioral response that develops in some people with use of narcotic medications. Now known as opioid use disorder.

Adjuvant analgesics

These drugs have been found to be effective pain relievers and are prescribed along with opioids in pain treatment plans.

Anticonvulsants

These medications are effective on neuropathic pain.

  • gabapentin
  • clonazepam

Antidepressants

Used to control neuropathic pain.

  • amitriptyline
  • nortriptyline

Corticosteriods

Anti-inflammatory agents that are useful in treating nociceptive (inflammatory) pain. These steroids are different from anabolic steroids. People using corticosteroids may experience temperament changes such as irritability and difficulty sleeping.