Opioids have made headlines in recent years. What are the real benefits and risks of their use?

 

What are opioids?

Opioids are also called opiates or narcotics. The most commonly used drugs in this category are morphine, codeine, oxycodone, hydromorphone and fentanyl. These substances are called "psychoactive" because they affect the areas of the brain that control the perception of pain to provide relief or "analgesia".

In recent years, their misuse has been widely publicized in the media, as a crisis is occurring across Canada and several thousand deaths have been linked to it. This is an important public health and safety issue that should not be trivialized.

 

When should opioids be used?

Opioids play a key role in the therapeutic arsenal to relieve severe pain. Used as prescribed by your doctor, and following the advice of your pharmacist, opioids are safe and effective in treating acute pain (e.g., after surgery) or chronic (e.g., cancer-related), as well as pain that is resistant to other pain treatments. 

They can play an important role in improving quality of life and autonomy for many people with otherwise very debilitating pain.

 

What are the risks associated with their use?

Side effects

Like all prescription drugs, narcotics can have some side effects. The most common include:

• drowsiness
• dizziness
• constipation
• dry mouth
• nausea
• headaches
• loss of appetite
• confusion, and
• moderate anxiety

Speak to your pharmacist if you are starting treatment with an opioid and you are particularly concerned about certain side effects. They will be able to advise you on measures to reduce them.

Addiction

The term addiction refers to the compulsive use of a substance, despite its harmful effects. When starting treatment with a narcotic, some people will experience a feeling of well-being called "euphoria" or "high". This feeling is largely responsible for the development of addiction in some susceptible individuals, but it fades over time. Some users will therefore be tempted to increase their doses on their own or to buy illicit products in order to regain this feeling.

Additionally, physical dependence can develop with prolonged use of opioids. For this reason, it is important not to stop taking an opioid abruptly. The dose should be reduced gradually to avoid withdrawal symptoms (e.g., anxiety, tremors, vomiting).

Overdose

An overdose can occur when the medication is taken improperly (e.g., dosage errors, tampering with the tablets without the pharmacist's advice). An overdose can result in slowed breathing and death if left untreated. Please visit the Health Canada webpage on overdose for more information.

 

How can a narcotic be used safely?

To minimize the risks associated with taking an opioid, here are some tips that may be helpful.

• Tell your doctor and pharmacist about other products and substances you are taking (e.g., prescription and over-the-counter medications, natural products, alcohol, recreational drugs) to avoid potentially dangerous interactions.
• When starting a treatment, carefully read the labels and fact sheets you receive and follow the instructions on dosage and frequency of use.
• Keep medications in their original containers for future reference and to reduce the risk of medication errors.
• Never change the condition of your medication (e.g., crushing a tablet) without talking to your pharmacist, as this can be very risky.
• Call your pharmacist for advice if you miss a dose or take an extra one.
• Do not drive or drink alcohol while under the influence of an opioid.
• Do not take any prescription or non-prescription sleep medication at the same time.
• Keep your medication out of the reach of children and adolescents to prevent accidents or misuse.
• Never share your medication with anyone.
• Return any unused medication to the pharmacy for safe disposal.
• Speak to your doctor or pharmacist if you are no longer able to follow your dosage, if your consumption habits are different or concerning, or if you feel that you need this type of product.

Many people can benefit greatly from the use of opioids for pain relief if they are aware of the side effects and risks. While great caution should be exercised in their use, they should not be ruled out as a potential treatment, nor should users be judged. Without these medications, users would likely lead a less active life and have a reduced ability to perform household (cleaning, laundry, cooking, etc.) and daily activities (bathing, dressing, etc.). Opioids have a place in pain management, that's for sure!

Speak to your pharmacist for additional information about opioids and other pain management medications.