Patient education: Taking opioids safely (The Basics)

What are opioids? — Opioids are a group of prescription medicines that relieve pain. They work by attaching to "opioid receptors" in the body and blocking pain signals.

Opioids are sometimes used when other types of pain medicine do not help enough. Opioids can be helpful for treating short-term, or "acute," pain, like after surgery or an injury. They are also sometimes used to treat long-term, or "chronic," pain, like for people with cancer. But they come with risks.

If your doctor prescribes an opioid medicine, it's important to understand the risks and know how to stay safe.

What are the risks of taking opioids? — You should know that:

●Opioids have side effects. Some are just bothersome, and some can be dangerous. For example, taking too much of an opioid is called an "overdose." An overdose can cause serious problems and even death.

●In some cases, taking opioids can lead to misuse. For example, people might take the medicine when they don't need it for pain. Or they might take more than they are supposed to. Sharing or selling opioids are other examples of misuse.

●There is a risk of addiction. This is also called "opioid use disorder."

If you take too much, or take opioids with alcohol or certain other drugs, it can cause serious harm. It can even cause death from overdose.

How do I stay safe? — There are things you can do to stay safe if you need to take an opioid medicine (figure 1). These things help protect yourself and others.

Know your medicines:

●Opioids come in different forms. "Immediate-release" medicines work quickly and last for a short time. "Extended-release" medicines work more slowly and last longer. Make sure that you know what type of opioid you have. Read the label and the information that comes with your prescription.

●Follow your treatment plan carefully. Take only the dose your doctor prescribes, and only as often as they tell you to.

●Never take opioids that were not prescribed to you.

●Some opioids come combined with other medicines like acetaminophen or an "NSAID" (like ibuprofen). Do not take any extra NSAIDs or acetaminophen without talking to your doctor first.

●Make sure that all of your doctors know every medicine you take, even those that are non-prescription. Some medicines can affect the way opioids work. Bring a complete list of all of your pain medicines and other medicines with you whenever you go to a doctor, nurse, dentist, or pharmacist.

●Ask your doctor or pharmacist if it is safe to take your other medicines with your opioid medicine.

Use and store your medicine safely:

●Do not drink alcohol while you are taking opioids.

●Do not take opioids with medicines that make you sleepy, unless your doctor tells you to. Examples include:

•"Benzodiazepines" like diazepam (sample brand name: Valium) or alprazolam (sample brand name: Xanax)

•Gabapentin (sample brand name: Neurontin) or pregabalin (brand name: Lyrica)

•Muscle relaxants like baclofen or cyclobenzaprine

•Sleeping pills like zolpidem (sample brand name: Ambien)

●Talk to your doctor about whether it is safe to drive. Opioids can make you feel tired or have trouble thinking clearly. If you are starting a new prescription or taking a higher dose, you might need to avoid things like driving, using dangerous machinery, or other activities that could be risky.

●Store your opioids in a safe place, such as a locked cabinet. This prevents children, teens, or anyone else from getting to them.

●Never share your opioids with other people.

Be aware of side effects:

●Opioid medicines can cause side effects. There are often ways to prevent or treat these.

●Call your doctor or nurse if you have side effects that bother you, such as:

•Constipation – Your doctor or nurse might suggest that you take a laxative to prevent or treat constipation. If your bowel movements are hard and dry, a stool softener might help. Drink plenty of water, and try to get regular physical activity.

•Mild nausea or stomach discomfort – Taking the medicine with or after food can help with this. Nausea usually gets better with time.

•Severe nausea, vomiting, or itchiness – If you have any of these problems, your doctor might be able to switch you to a different medicine.

•Dry mouth

•Feeling dizzy or sleepy, or having trouble thinking clearly

•Vision problems

•Being clumsy or falling down

●Know the signs of an opioid overdose. Get help right away if you think that you or someone else took too much of an opioid medicine. Signs of an overdose are listed below.

Stay safe when stopping your opioid medicine:

●When opioids are needed to treat acute pain, doctors usually try to prescribe them for only a short time. This usually means a few days or a week. They also prescribe the lowest dose possible to relieve pain.

●Follow your doctor's instructions about how to stop taking your opioid once your pain has improved. This usually involves "tapering," or reducing the dose gradually. If you stop an opioid suddenly, this can cause unpleasant symptoms like stomach ache, diarrhea, or shakes. This is called "withdrawal." Tapering the dose can help prevent withdrawal.

●When your pain gets better, get rid of any leftover medicines. Your doctor, nurse, or pharmacist can suggest ways to get rid of them. This might involve flushing them down the toilet or mixing them with something like dirt or cat litter, then putting the mixture in a sealed container in the trash. Some police stations and pharmacies also take leftover medicines.

What is naloxone? — Naloxone is a medicine that reverses the effects of opioids. It can prevent death from an opioid overdose. Naloxone comes as an injection (shot), or as a spray that goes in the nose. Naloxone nasal spray (brand name: Narcan) is available without a prescription.

If you or someone you know uses opioids, it's a good idea to keep naloxone with you. Make sure that you and your family and friends know how and when to use it.

When should I call for help? — If you are taking an opioid, it's important to know when to get help. Signs of an opioid overdose include:

●Extreme sleepiness

●Slow breathing, or no breathing at all

●Very small pupils (the black circles in the center of the eyes)

●Very slow heartbeat

If you took too much of your opioid medicine or think that someone is having an opioid overdose:

●If you have naloxone, give it immediately. Naloxone can save a person's life. But it needs to be given as soon as possible.

●Call for an ambulance right away (in the US and Canada, call 9-1-1).

Call your doctor or nurse if:

●You are having side effects that bother you.

●You have questions about how to take your medicine.

●You are having trouble managing your pain.

More on this topic

Patient education: Medication safety (The Basics)
Patient education: Managing acute pain at home (The Basics)
Patient education: Managing pain after surgery (The Basics)
Patient education: Managing pain when you have cancer (The Basics)
Patient education: Opioid overdose (The Basics)
Patient education: How to give naloxone (The Basics)
Patient education: Opioid use disorder (The Basics)
Patient education: Prescription drug misuse (The Basics)
Patient education: Substance use disorder (The Basics)
Patient education: Chronic pain (The Basics)
Patient education: Side effects from medicines (The Basics)