Prescription Opioid Misuse

The opioid epidemic in the U.S. has lawmakers working on legislation to tackle the growing problem —  one the Centers for Disease Control and Prevention says has quadrupled, in part, due to the misuse of prescription painkillers. Mayo Clinic anesthesiologist Dr. W. Michael Hooten says prescription opioid overdoses take more lives than heroin. More than 750,000 people have died since 1999 from a drug overdose. Two out of three drug overdose deaths in 2018 involved an opioid and Opioids are substances that work in the nervous system of the body or in specific receptors in the brain to reduce the intensity of pain. Overdose deaths involving opioids, including prescription opioids, heroin, and synthetic opioids (like fentanyl), have increased almost six times since 1999. Overdoses involving opioids killed nearly 47,000 people in 2018, and 32% of those deaths involved prescription opioids.

What are the signs of an addiction?

People addicted to drugs may change their behavior. Possible signs include:

• Mixing with different groups of people or changing friends
• Spending time alone and avoiding time with family and friends
• Losing interest in activities
• Not bathing, changing clothes or brushing their teeth
• Being very tired and sad
• Eating more or less than usual
• Being overly energetic, talking fast and saying things that don’t make sense
• Being nervous or cranky
• Quickly changing moods
• Sleeping at odd hours
• Missing important appointments
• Getting into trouble with the law
• Attending work or school on an erratic schedule
• Experiencing financial hardship

What are opioid withdrawal symptoms and how can you alleviate them?

Opioid withdrawal symptoms can but won’t necessarily include some of the following:

• Drug cravings
• Anxiety/irritability
• Insomnia
• Abdominal pain
• Vomiting
• Diarrhea
• Tremors (shaking)
• Feeling cold

Opioid withdrawal symptoms generally last between three and five days, although they can last up to 10 days, according to the American Society of Addiction Medicine (ASAM).

Withdrawal from opioids can be difficult and even dangerous. Trying to quit “cold turkey” is not recommended, ASAM advises, because it can lead to stronger cravings and continued use. The safest way to alleviate opioid withdrawal symptoms is through medically supervised treatment that generally includes medicines, counseling and support. Some medications used to relieve withdrawal symptoms are methadone and buprenorphine (Subutex). These medications also can be used as long-term maintenance medicine for opioid dependence. In addition, a medication called clonidine can be used during withdrawal to help reduce anxiety, agitation, muscle aches, sweating, runny nose and cramping. It does not help reduce cravings. The addiction medicine physician may also prescribe medication to treat vomiting and diarrhea and help with insomnia.

What are the symptoms of an opioid overdose?

Signs of an overdose include:

• Slow, shallow breathing
• Extreme sleepiness
• Inability to talk
• Blue skin color and dark-colored lips
• Snoring or gurgling sounds

How should you respond to an opioid overdose?

If you think someone may be experiencing an opioid overdose, take the following actions immediately:

1. Lightly tap, shake and shout at the person to get a response. If you do not get a response, rub your knuckles on the person’s breastbone.
2. If the individual responds, keep the person awake.
3. Call 911.

How to use opioids safely

If you are taking opioids or talking with your health care provider about this treatment option, now is the time to plan for safe use and disposal of these medications. Practicing caution can mean the difference between life and death for you, your loved ones and your neighbors.

Opioid painkillers are highly addictive. After just five days of prescription opioid use, the likelihood that you'll develop long-term dependence on these drugs rises steeply — increasing your risk of eventual addiction and overdose. And you don't need a prescription to be at risk. Most people who misuse prescription painkillers report getting them from a family member or friend. Your medical, family and personal history of substance use all help determine whether opioids are safe for you. It’s important that health care providers prescreen populations before they initiate these drugs. "So there are a variety of things that physicians need to consider when they initiate a course of opioid therapy," says Dr. Holly Geyer, a Mayo Clinic addiction medicine specialist. "It's always a concern when patients have histories that predispose them to having secondary complications from using opioids. Issues with drug and alcohol abuse, active issues, or prior issues, and family history issues with drug and alcohol abuse, problems with sleep disorders or primary lung problems can predispose a patient to issues."

What are the most important things you need to know about your medicines?

Make sure you know about each of the medicines you take. This includes why you take it, how to take it, what you can expect while you're taking it, and any warnings about the medicine.

The information provided here is general. So be sure to read the information that came with your medicine. If you have any questions or concerns, talk to your pharmacist or doctor.

Why are opioids used?

Opioids are used to relieve moderate to severe pain. They may be used for a short time, such as after surgery, or for long-term pain.

Opioids don't cure a health problem. But they help you manage the pain.

What are some examples of opioids?

Here are some examples of opioids and other medicines that have opioids in them. For each item in the list, the generic name is first, followed by any brand names.

• codeine (Tylenol 3)
• hydrocodone (Norco)
• oxycodone (OxyContin, Percocet)

This is not a complete list of opioids.

What about side effects?

Some people feel sleepy, feel dizzy or lightheaded, have nausea or vomiting, or become constipated while using an opioid.

General information about side effects

All medicines can cause side effects. Many people don't have side effects. And minor side effects sometimes go away after a while.

But sometimes side effects can be a problem or can be serious.

If you're having problems with side effects, talk to your doctor. He or she may be able to lower your dose or change to a different medicine.

Always be sure you get specific information on the medicine you're taking. For a full list of side effects, check the information that came with the medicine you're using. If you have questions, talk to your pharmacist or doctor.

If you're taking opioids as part of a supervised care plan, tolerance and withdrawal may not mean that you have opioid use disorder.

Cautions for all medicines

• Allergic reactions: All medicines can cause a reaction. This can sometimes be an emergency. Before you take any new medicine, tell the doctor or pharmacist about any past allergic reactions you've had.
• Drug interactions: Sometimes one medicine may keep another medicine from working well. Or you may get a side effect you didn't expect. Medicines may also interact with certain foods or drinks, like grapefruit juice and alcohol. Some interactions can be dangerous.
• Harm to unborn babies and newborns: If you are pregnant, trying to get pregnant, or breastfeeding, ask your doctor or pharmacist if any of the medicines you take could harm your baby.
• Other health problems: Before taking a medicine, be sure your doctor or pharmacist knows about all your health problems. Other health problems may affect your medicine. Or the medicine for one health problem may affect another health problem.

Always tell your doctor or pharmacist about all the medicines you take. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. That information will help prevent serious problems.

Always be sure you get specific information on the medicine you're taking. For a full list of warnings, check the information that came with the medicine you're using. If you have questions, talk to your pharmacist or doctor.

Resources:

https://newsnetwork.mayoclinic.org/discussion/how-to-use-opioids-safely/

https://www.hhs.gov/opioids/about-the-epidemic/opioid-crisis-statistics/index.html

https://www.asahq.org/whensecondscount/pain-management/opioid-treatment/opioid-abuse/

https://www.stlukesonline.org/health-services/health-information/healthwise/2017/06/27/13/19/opioids