Opioids

What are opioids?

Opioids are strong pain medicines. They can be taken by mouth, as an injection (shot), through a patch, or in a vein (IV). There are different types of opioids, and some are stronger than others. Common opioids include hydrocodone (Vicodin®), morphine, hydromorphone (Dilaudid®), oxycodone, fentanyl, and methadone.

Pain management is an important part of patient care, and medicine can be a helpful tool. However, the use and misuse of opioids has led to an opioid crisis in the United States and other countries.

If your doctor prescribes an opioid for your child, be sure to follow all instructions to manage pain safely and effectively.

Opioids for pain management

Your child might have pain from surgery, cancer or other disease, or their medical treatment. Doctors prescribe opioids if:

Your child’s pain is moderate to severe, and other medicines do not control it

Your child cannot take other pain medicines at that time

Opioids do not completely relieve pain. Opioids do not work for all types of pain. Your doctor may prescribe other medicine or other ways of handling pain. Read more about types of pain and pain management.

Possible side effects of opioid medicines

Opioids can cause many different side effects. Some side effects are more common than others.

Common side effects of opioids

• Nausea
• Itching
• Dizziness or confusion
• Difficulty urinating (peeing)
• Constipation (difficulty having a bowel movement)
• Difficulty driving or using machinery
• Harm to an unborn child

Less common side effects of opioids

• Slow breathing
• Allergic reaction
• Acting different, sleepy, or slow
• Addiction or improper use of the medicine

Opioid addiction and dependence

About addiction

Addiction is when you want to use a medicine in ways other than how the doctor prescribed it. For example, you might take it to feel “high,” instead of to control pain. Addiction can also happen with street drugs or other substances.

Opioids work by blocking pain signals sent from the body to the brain. They also cause the release of dopamine, which can make people “feel good” and produce a “high.” The user may want to repeat the experience. This desire may lead people to take opioids for non-medical reasons.

Some people misuse opioid medicines. Patients who take opioid medicines before age 18 are more likely to become addicted later. So, addiction is a possible risk of taking opioid medicines.

About dependence

Dependence is when your body gets used to a medicine or other substance. Opioids are a type of drug that the body gets used to having.

It is normal to get used to opioids if you take them for more than a few days. This means your child’s body might feel like it needs opioids after a short time. The dose that worked before might not work as well.

Dependence is different from addiction. Addiction is in a person’s mind and emotions as well as their physical body.

If your child does take opioid medicines, your care team will help lower the dose safely when it is time.

Opioids and pregnancy

Opioids can be harmful to an unborn baby. If a woman becomes pregnant while taking opioids, the baby could be born dependent on opioids. The baby might also have health problems.

Take steps to avoid pregnancy while taking opioids. See a doctor right away if you become pregnant while taking opioid medicines.

Deciding about opioids

Managing pain is an important part of your child’s treatment. Pain that is not controlled can harm your child.

However, having your child take opioid medicines is a serious decision because of the possible risks. Be sure to discuss the risks with your child’s doctor. Also talk with your child if they are old enough. You might be asked to sign a document called “informed consent,” showing that you know and understand the risks. Your care team will help you develop a plan to control your child’s pain in the best and safest way possible.

Signs of opioid misuse

Changes in daily behavior

• Doing fewer daily activities or not able to function normally
• Hoarding opioid medicines or other drugs
• Reporting pain when they seem comfortable
• Getting upset when discussing taking a lower dose or taking opioids less often

Changes in taking medicine

• Taking a different dose, taking medicine more often, or taking opioids with other medicines the doctor did not prescribe
• Taking other medicines or substances for pain
• Using opioid medicines for problems other than pain, such as feeling anxious or having sleep problems
• Taking too much medicine on purpose to calm down or go to sleep
• Saying they want to feel “high” from the medicine

Changes in doctor visits and prescription use

• Asking several doctors for opioid medicines, or asking for these medicines at an urgent care clinic or emergency department
• Calling the doctor’s office often for prescriptions, or trying to get a prescription without making an appointment
• Saying the opioid medicines were lost or stolen
• Having fewer pills left than they should have if they are following the doctor’s prescription
• Asking for specific opioid medicines by name
• Wanting to keep taking opioids at the same or a higher dose

Illegal behavior

• Using drugs or prescription medicines in secret
• Stealing or selling prescription drugs
• Getting opioid medicines from a drug dealer or someone else who is not a doctor
• Faking or altering a prescription (prescription tampering or forgery)

Risk factors for opioid misuse and addiction

Opioids can have many benefits for pain management. However, anyone who takes opioid medicines is at risk for addiction. Factors that can increase your child’s risk for addiction or misuse include:

• Being a teen or young adult — Risk for abuse typically increases during teenage years and peaks during young adulthood.
• Longer use of opioids — Long-term opioid use or taking multiple types of opioids can increase risk.
• Personal or family history of substance abuse
• Behavioral and academic problems
• Childhood sexual abuse
• Mental health disorders such as depression or anxiety
• Peer or social pressures for substance use

Ways to monitor opioid use

The care team can monitor patients to make sure opioids are used correctly. Monitoring can include:

• Pill counts - A team member may count pills to ensure patients are not taking more pills than prescribed or that pills are not being stolen from the patient’s supply.
• Urine drug test - Patients may have urine drug tests, so the care team can check for opioids and other substances.
• Pain diary - Patients and families can keep a pain diary to track the number of pills the patient takes each day, pain rating, and any side effects.

How to store opioid medicines

Store opioid medicines carefully. Keep them in a safe, lockbox, or locked cabinet. Or you might put them where they are not easy to find.

Always store opioids and other medicines out of reach of children to avoid poisoning. You might want to keep opioids with you when you are not home. For example, you might carry them in your purse instead of leaving them home near your child.

Bring your child’s opioid medicines to any doctor’s appointments where you discuss managing pain. The staff might check and count the pills with you.

How to dispose of unused medicine

Do not save your child’s medicine “just in case.” Someone might find it and use it wrongly. If your child needs pain medicines again, the doctor can prescribe the best option.

Do not give opioids to someone else. This is against the law. It could also hurt the person you give them to.

• Return opioid medicines to your hospital or clinic. Some hospitals or clinics have MedSafe™ or a medicine return container near the pharmacy window. If you are on a trial medication or experimental medication, please consult your care team or pharmacist on where to return that medication.
• You may also throw away opioid medicines. To throw them away, take the medicine out of the original container, and mix the medicine with used coffee grounds, used cat litter, or something else no one would want to eat. Put the mixture in a sealed plastic container and throw it in your trash.
• Take unused medicine to a drug take-back location in your community. Find more information or locate a public collection site here.

If you have questions about opioids, please talk to your child’s doctor, nurse, or pharmacist.