Opioid drugs: Use with caution

Abuse of opioid pain relievers is a serious and growing public health concern in the U.S., and around the world. If you need to take opioids, carefully weigh the risks and benefits with your doctor — especially if they’re being prescribed for chronic non-cancer pain rather than for temporary pain resulting from an injury or operation.

When are opioids recommended?

New guidelines from the Centers for Disease Control (CDC) state that nonopioid therapy is preferred for chronic pain associated with conditions such as arthritis, back pain, neuropathy and fibromyalgia. Nonopioid approaches to care may include:

  • Acetaminophen or ibuprofen
  • Physical therapy and exercise
  • Cognitive behavioral therapy
  • Support groups

When opioids are used for chronic pain, the lowest possible dose should be prescribed. Fifty milligrams a day of morphine or the equivalent-strength dose of another opioid is considered relatively low-risk by the CDC. For anyone taking more than 90 milligrams a day, the CDC recommends an evaluation by a pain or addiction specialist. Tapering down the dose may be necessary to avoid withdrawal symptoms.

Your doctors should always exercise caution when prescribing opioids, talk to you about the risks and help you make an informed decision about pain relief. If you do decide to take opioids, your physician should monitor you closely.

What are the risks of taking opioids?

Although they are very effective at managing pain, opioids should be taken with care: If used without caution they can lead to physical dependence, addiction or overdose.

  • Physical dependency. Over time, the body builds up a tolerance to opioids, meaning higher doses are needed to achieve the same level of pain relief. This can lead to drug dependence, resulting in withdrawal symptoms, such as anxiety, shaking and vomiting, when you stop taking the medicine.
  • Addiction: In addition to relieving pain, opioids can create feelings of euphoria by causing the body to release artificial endorphins, or feel-good chemicals. Overusing opioids can cause the brain to stop making its own endorphins. This leads to a compulsion to take higher doses of opioids, regardless of the negative side effects. A person who is abusing opioids may experience:
    • Poor coordination
    • Drowsiness
    • Depression and anxiety
    • Poor decision-making
    • Slurred speech
    • Irritability
    • Decreased motivation

You may be at a heightened risk of becoming addicted to opioids if you have a personal or family history of substance addiction or abuse. A history of mental health conditions, such as severe depression and anxiety, also increases your risk.

  • Overdose. Taking too a high a dose of opioids can be fatal. According to the CDC, more than 40 Americans die from prescription opioid overdoses each day. Symptoms of overdose include:
    • Passing out
    • An inability to wake up
    • Irregular breathing or no breathing
    • Irregular pulse
    • Vomiting
    • Small pupils

Even people who would typically not be at increased risk of addiction can be vulnerable to overdose. Overdoses can occur from accidentally taking too much of the drug or combining it with alcohol or other medications such as sedatives.

If you’re concerned about opioid use – either for yourself or for someone you love – please contact the UCLA Center for Behavioral and Addiction Medicine.


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