Author: Mona Bapat, Ph.D., HSPP

Whether you are considering taking opioids to manage chronic long-term pain, for pain after an upcoming surgery, or to achieve opioid effects (the “high” they produce), it is important to know the types of opioids, their addictive potential, addiction warning signs, opioids side effects and what to discuss with your doctor to determine the best pain-management plan for you.

Opiates vs. Opioids

Opioids fall into the class of medications called analgesics, meaning that they work to relieve pain.

The terms opiates and opioids are often used interchangeably; however, they are different. “Opioid” is the umbrella term referring to all:

• Natural opioids
• Semisynthetic opioids, which are those manmade from a natural substance
• Synthetic opioids are those that are completely manmade through a chemical process.

Opiates are natural opioids; they are the chemicals found naturally in the poppy seed. Examples of opiates include:

• Heroin
• Morphine
• Codeine

Semisynthetic opioids include:

• Hydromorphone
• Hydrocodone
• Oxycodone (brand name OxyContin)

Fentanyl is a very powerful synthetic opioid. It is approximately 50 to 100 times more potent than morphine and has led to a steep rise in opioid overdoses. Other synthetic opioids include:

• Methadone
• Tramadol
• Buprenorphine

Common opioids that doctors prescribe for pain include:

• Codeine
• Fentanyl
• Hydrocodone (Vicodin)
• Oxycodone (OxyContin, Percocet)
• Oxymorphone
• Morphine (Kadian, MS Contin)

Short-Term Opioid Side Effects

The most common side effects of opioids include:¹

• Constipation
• Mental fogginess
• Nausea

Other side effects of prescription opioids, even when taken as directed, can include:

• Increased sensitivity to pain
• Sleepiness and dizziness
• Confusion
• Itching and sweating
• Low levels of testosterone
• Depression

Be sure to talk with your doctor if you experience depression, as it may need to be further evaluated and treated.

Effects on the Immune System

In addition to their addictive potential, some opioids may also suppress your body’s immune response, in turn increasing vulnerability to infections. Morphine, fentanyl and oxycodone are known to harm the immune system.⁷

Long-Term Side Effects of Opioids

Opioids are highly addictive because they trigger the release of excessive amounts of dopamine in the brain. Dopamine is a critical neurotransmitter that plays a role in the reward cycle. In addition to pain suppression, this rush of dopamine creates a feeling of euphoria. Thereby, using can quickly develop into a cycle of using to feel “good”, needing more to get the same effect and finally needing the drug to function normally.

The longer you use opioids, the higher the risk you have of developing an opioid use disorder (OUD), meaning that you continue to use opioids despite the negative impacts on your health and overall well-being.

Tolerance and Withdrawal

Tolerance and withdrawal from opioid use can develop very quickly. Tolerance means that your body has gotten used to the substance, and so over time, it needs more and more to produce the desired effect. This occurs because your body starts to slow its natural production of dopamine.

Withdrawal occurs when you use an opioid for a significant amount of time, so that when you suddenly stop or quit “cold turkey,” your body struggles to function normally. This can be a very uncomfortable or even a painful experience.

Opioid withdrawal symptoms can include:

• Muscle pain
• Nausea, vomiting or diarrhea
• Restlessness
• Sweating
• Anxiety
• Dilated pupils or watery eyes
• Runny nose or yawning
• Cramping abdominal pain
• Fast heart rate or elevated blood pressure
• Goosebumps
• Insomnia
• Tremor

Opioid Addiction and Overdose

Because of their addictive potential, doctors usually prescribe opioids for about 3 days to manage acute (short-term) pain, such as post-surgery or post-injury pain.

For acute pain, there are opioid medications that have lower addictive potential that you should discuss with your doctor, especially if you have any concern over misuse.

These medications include:

• Morphine sulfate, immediate-release (MSIR)
• Tramadol
• Tapentadol

Though these medications are also opioid analgesics, they cause a lower degree of euphoria because they are less potent or don’t affect the reward centers in the brain as strongly. This reduces their addictive potential.

Your doctor may also put you on a tapering schedule toward the end of your medication regimen. This means that the doctor will slowly lower your dose over time rather than having you stop taking it abruptly. In other words, it is a way of weaning you off opioids to avoid experiencing withdrawal.

To get help for opioid addiction, call 800-934-1582(Sponsored)

Who Is At Risk for Addiction?

Because opioids carry a high risk for addiction, anyone using one of these substances has the potential to develop addiction. However, studies have shown that women have a greater risk of developing opioid dependence, as well as individuals who are members of the LGBTQ+ community.

Some factors that put you at higher risk of misusing opioids include:

• History of substance abuse, especially polysubstance use
• Long-term or high-dose prescription use
• Chronic pain
• High stress environments or circumstances such as unemployment, homelessness or poverty
• Family history of substance abuse
• Young age
• History of mental health disorders, such as clinical depression or anxiety
• Heavy tobacco use

Opioid Overdose

Signs of opioid overdose can include:

• Slow, shallow breathing
• Choking or gurgling sounds
• Limp body
• Pale, blue or cold skin
• Small, constricted pupils
• Sleep or loss of consciousness

If you notice any of these signs in yourself or a loved one, call 9-1-1 right away, because an overdose is a potentially life-threatening event.

Questions to Ask Your Doctor

Having an honest and thorough discussion with your doctor can help to set the best pain management goals for you. If you are considering opioid use for a medical condition, some questions to ask your doctor include:¹

• How long will I be taking the opioid for pain management?
• Can you help me understand what my baseline pain level is?
• How should I rate my pain day-to-day so that I can judge improvements?
• What side effects can I expect?
• Are there potential drug interactions with the medications I’m currently taking? Should I avoid certain foods or substances while taking opioids?
• What do I do if I accidentally overdose on the opioid?
• What tapering plan can we establish to avoid withdrawal symptoms?
• What can we do to reduce my risks of developing an OUD?
• How do I safely store the medication and dispose of unused opioid medication?
• I am pregnant or plan to become pregnant, so what pain medication would you recommend?
• Are there options for me besides opioids?

No matter your physical or mental health history, no one is immune to the dangers of opioids. Being mindful of this and having a carefully laid-out treatment plan with your doctor can help to minimize your risks. Your doctor can help you weigh the benefits versus the risks of opioid medications for your unique situation.

Treatment is effective for those struggling with an OUD. If you are dealing with illicit opioid use or an OUD, the sooner you seek treatment, the better the prognosis for recovery.

Studies looking at the success rate of medication-assisted treatment for OUD found that for many, using medications such as buprenophine or methadone greatly increases a person’s chances of sustained recovery. In fact, in a 3-year study, roughly 30% to 50% of people utilizing MAT as a part of their comprehensive treatment plan were abstinent from opioid abuse after three years.

If you’re worried about your level of opioid use or that of a loved one, get help today at 800-934-1582(Sponsored) .

References

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7. Plein, L.M., & Rittner, H.L. (2018). Opioids and the immune system-friend or foe. British Journal of Pharmacology, 175, 2717-2725.
8. Ray, W.A., Chung, C.P., Murray, K.T., Hall, K., & Stein, C.M. (2016). Prescription of long-acting opioids and mortality in patients with chronic noncancer pain. Journal of the American Medical Association, 315(22), 2416-2423.
9. Deyo, R.A., Von Korff, M., & Duhrkoop, D. (2015). Opioids for low back pain. BMJ, 350.
10. Weiss, R.D., Potter, J.S., Griffin, M.L., Provost, S.E., Fitzmaurice, G.M., McDermott, K.A., Srisarajivakul, E.N., Dodd, D.R., Dreifuss, J.A., McHugh, R.K., & Carroll, K.M. (2015). Long-term outcomes from the National Drug Abuse Treatment Clinical Trials Network Prescription Opioid Addiction Treatment Study. Drug and Alcohol Dependence; 150, 112-119.

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