Opioid pain killers: what you need to know about safety

How to take opioid pain killers safely?

  1. DO take your opioid and non-opioid pain medicines as prescribed. Make sure you take the right dose of medication at the right time. Don’t avoid taking your pain medication to save it for a later time. Don’t take someone else’s prescriptions.
  2. DON’T take extra doses. If you take extra doses without the direction of your health care provider, you could become very sick or even die from an opioid overdose. You may also run out of your opioids before you can refill your medication. This may lead to withdrawal symptoms (see next page). Your provider will usually deny requests for early refills. This protects you and the public from harm due to opioid abuse and addiction. If you have severe, increased or new pain, don’t just take more of your opioids. Call your pain treatment provider or clinic to decide on the best care.
  3. DO inform all of your providers that you are currently prescribed opioids.
  4. DO tell your primary health care provider if another provider prescribes an opioid for you. Tell your primary health care provider within 24 hours or on the next weekday if another provider prescribes an opioid (for example, for acute pain after surgery).
  5. DO make an effort to remain in the care of one primary provider. This will help ensure the right amount and type of medication is prescribed so you have optimal pain management and continued care.
  6. DO tell your primary health care provider about any other health care that you are receiving from additional providers (e.g., behavioral health, interdisciplinary team). Tell your primary care provider about all medications and supplements you currently take. This includes illegal or legal use of marijuana that providers outside VA and DoD may have prescribed. Coordination of pain management services is important to ensure your safety. You should know that your primary health care provider may choose to alter your pain management plan of care, including long-term use of opioid therapy, to take into account all care that raises safety concerns.
  7. DON’T stop taking opioids on your own. If you stop taking opioids suddenly, you may have withdrawal symptoms. If your provider asks you to slowly decrease your use of opioids, follow the provider’s instructions closely. This will help reduce withdrawal symptoms and prevent you from feeling sick.
  8. DO be cautious about driving or operating machinery. Avoid driving a motor vehicle or operating dangerous machinery if you feel sleepy or confused after taking a medication. State laws may determine what kinds of jobs you can do when taking opioids.
  9. DON’T drink alcohol or take “street drugs.” It is not safe to drink alcohol or use illegal “street drugs” when you are taking opioids. They can impair your ability to manage your opioid therapy and cause severe harm or death. Some drugs can interfere with your pain care or opioid therapy. If you abuse alcohol or use “street drugs,” your provider will encourage you to get treatment for this problem and may stop prescribing opioids. Treatment for alcohol or drug abuse will not interfere with your ability to get treatment for your pain or other conditions – and treatment for alcohol or drug abuse may be helpful.
  10. DO get help from your friends and family. Your friends and family may be able to work with your health care provider to help you manage your opioid therapy safely. Your health care provider may encourage you to involve your friends and family to learn about opioids. They may also ask for permission to contact your family about your opioid pain care. Social support is an important component of pain management.
  11. DON’T sell or give away your opioids. Don’t let other people take or use your medicines. This is dangerous, illegal and can lead to criminal charges. Keep your medicines in a safe and secure place. VA and DoD may not replace doses that are lost, stolen or shared with others. If this happens repeatedly, your provider may stop prescribing opioids to you completely.

What adverse effects should I be aware while taking opioids?

It is important to report any side effects to your provider. Tell your provider if any side effects interfere with your daily activities. This information will help you and your provider develop a treatment plan that balances harms (side effects and risks) and benefits (pain relief and how well you function).

  1. Sleepiness or “slow thinking”: Opioids can impair your judgment and cause problems with how you make decisions. Sleepiness may lessen over time.
  2. Mental confusion, bad dreams or hallucinations: Your provider may need to change your dose or medicine to treat these side effects.
  3. Constipation: This is a common side effect that may not go away. Your provider may prescribe laxatives to improve your bowel movements. Regular physical activity, a diet high in fiber and drinking more water may also help.
  4. Itching:
  • Itching is rare.
  • It usually occurs early in treatment.
  • Your provider may need to change your opioids and order medicine to treat itching.
  1. Sweating: Wearing light clothes may help decrease sweating.
  2. Nausea and vomiting: This can occur early or late in treatment and usually goes away with time. Your provider may prescribe medication to help control nausea.
  3. Decreased hormones that affect sex drive, sexual arousal and other aspects of your health: Opioid use may decrease sex hormone levels and your desire to have sex. For men, opioids may decrease the ability to have an erection. People with decreased sex hormones may experience depression, anxiety, tiredness, hot flashes and night sweats. It can also cause loss of muscle mass, weakness, brittle bones (osteoporosis) and bone fractures. Women may have irregular or no menstrual periods. Use effective birth control methods to prevent pregnancy during opioid treatment. Tell your provider if you are pregnant or plan to become pregnant. Opioids may harm your baby if taken while pregnant.
  4. Allergies: Allergic reactions to opioids are rare. If you get a rash or hives, call your provider or 911 right away. If you become short of breath, have throat swelling or feel like you may pass out, tell someone to call 911 right away.
  5. Sleep apnea: Sleep apnea is abnormal breathing pauses during sleep. This is a serious risk. Your health care provider may: ƒ
  • Ask you about your sleep habits ƒ
  • Order tests to check if you are at risk for sleep apnea

If you have sleep apnea, your health care provider may: ƒ

  • Advise you to use only non-opioid pain therapy ƒ
  • Prescribe a breathing machine to use when you go to sleep ƒ
  • Advise you to avoid alcohol and medicines that may make sleep apnea worse
  1. Worsening of pain For some people, opioids may actually make pain worse.
  2. Impaired driving:

Opioids may affect your ability to drive a car or use other machinery safely. ƒ

  • Avoid driving a motor vehicle or operating dangerous machinery if you feel sleepy or confused after taking a medication ƒ
  • To ensure public safety, state laws may determine what kinds of jobs you can do when taking opioids
  1. Tolerance: With long-term opioid therapy, you may need a higher dose to get the same pain relief, which may result in an increase in the likelihood of many of the other side effects and risks. 13. Withdrawal symptoms (physical dependence) Your body will get used to receiving opioid medication. You may suffer withdrawal symptoms if you suddenly stop taking opioids, taper them too quickly or take a drug that blocks the effects of the opioids. People who take opioids for a prolonged period of time become physically dependent on them. Physical dependence is NOT the same as addiction.
  2. Addiction: Some—not all—patients become addicted to opioids. Addiction occurs when a craving for a substance gets out of control. If you show any signs of addiction, your provider is likely to refer you to an addiction specialist or a substance use treatment program. ƒ
  • Your provider and addiction specialist may cut back on your dose or stop opioid therapy ƒ
  • They may prescribe non-opioid medicines ƒ
  • They may use non-opioid treatments to help with your pain
  1. Drug interactions: Sometimes there are problems when different drugs are taken together. Tell your provider about all of the different medications you take. This is includes both prescription and over-the-counter drugs, as well as herbs or vitamins. Tell your doctor if you drink alcohol.
  2. Immune system changes: Your body’s immune system helps fight infections. Opioids may weaken the immune system. Long-term opioid use may result in infections or immune-related illnesses.
  3. Birth Defects: Opioid use during early pregnancy has been associated with an increased risk of rare birth defects. If you are or plan to become pregnant, talk to your health care provider about your pain treatment options. 10. Increased Risk of Death Opioids are one of the main prescription drugs associated with death in the United States. Death may be more likely when you take larger doses of opioids as opioids may cause respiratory depression.

Important note

This document is prepared by the “Mental Health for All” team. The general information provided on the Website is for informational purposes only and is not professional medical advice, diagnosis, treatment, or care, nor is it intended to be a substitute therefore. Always seek the advice of your physician or other qualified health provider properly licensed to practise medicine or general healthcare in your jurisdiction concerning any questions you may have regarding any information obtained from this Website and any medical condition you believe may be relevant to you or to someone else. Never disregard professional medical advice or delay in seeking it because of something you have read on this Website. Always consult with your physician or other qualified healthcare provider before embarking on a new treatment, diet, or fitness program. Information obtained on the Website is not exhaustive and does not cover all diseases, ailments, physical conditions, or their treatment.

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