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Prescription Opioids

Risk factors, physical and mental side effects, and how to start recovery and treatment

To relieve pain for illness or injury, medical providers may prescribe an opioid such as hydrocodone, morphine, oxycodone, or oxymorphone. Patients experiencing severe pain from advanced cancer, surgery, or other major medical problems may also be prescribed pharmaceutical fentanyl, a synthetic opioid that’s 50–100 times as strong as morphine.

Prescription opioids can provide a medical benefit if taken under a doctor’s orders. But misuse of and dependence on prescription opioids can lead to harm and even death from the drugs’ serious side effects.

If you are dependent on prescription opioids, seek treatment.

Recovery from prescription opioid misuse is possible.

Prescription opioid types and risks

Prescription opioids are often classified as short- and long-acting medications based on the onset and duration of their pain-relieving effects. They are sold under various brand names. Common examples include:

  • Actiq, a short-acting form of prescription fentanyl.
  • MS Contin, a long-acting form of morphine.
  • Oxycontin, a long-acting form of oxycodone.

Opioids are also sometimes combined with nonopioid pain relievers, such as acetaminophen (Tylenol). Oxycodone-acetaminophen is marketed under the brand name Percocet, while hydrocodone-acetaminophen is sold as Lortab. Vicodin, another well-known brand of hydrocodone-acetaminophen, is no longer available.

Opioid painkillers have a chemical makeup similar to the illegal drug heroin. Dependence can form over time, and taking too much of these substances can slow breathing, induce coma, and cause brain damage or death.

Prescription opioid misuse, dependence, and overdoses have caused a public health crisis. According to government data, 9.5 million people ages 12 and older misused opioids in 2020; of those, 9.3 million misused prescription opioid pain relievers, while 902,000 people used heroin. Some of the most common prescription drugs involved in overdoses are hydrocodone, methadone, and oxycodone.

If you obtain and misuse counterfeit prescription opioids or illegal drugs such as cocaine, heroin, and methamphetamine, you may also be ingesting fentanyl, a highly potent opioid. Illegal drugs are increasingly being laced with fentanyl, which is heavily contributing to record rates of overdose death.

These additional factors could increase your risk of misusing, becoming dependent on, and facing serious harm from prescription opioids:

Age, lifestyle, and medical history. Dependence is more likely if you use or have used other drugs, have an untreated mental illness, or live in a situation that enables drug misuse. You may be at greater risk of overdosing on prescription opioids if you are over age 65 or have a health condition such as sleep-disordered breathing, end-organ dysfunction, or lung disease. Meanwhile, the rate of nonmedical opioid use is highest among people ages 18 to 25, and most people who misuse prescription opioids start using the drug in their early to late 20s. Prescription opioid overdose deaths occur mostly among people aged 25 to 54.

High dosage. Taking a higher dose comes with a greater risk of dependence than taking a lower dose does, but even taking a low dose is risky, according to Centers for Disease Control and Prevention (CDC) prescribing guidelines.

Long-term use. If you use opioids for even a few days, you could become dependent. An estimated 1 in 4 people receiving prescription opioids long-term in a primary care setting become dependent, according to research summarized by the CDC.

Extended-release formulations. Dependence is more common with drugs that act over a longer period than with those that act more immediately, CDC guidelines say.

Mixing prescription opioids with other substances. You increase your risk of serious harm, including overdosing, if you mix opioids with other substances. This is especially true for substances that make you drowsy, such as alcohol, benzodiazepines such as Valium or Xanax, muscle relaxants like Soma, and sleep aids such as Ambien.

Signs of prescription opioid misuse or dependence include:

  • Taking pills in greater amounts or more frequently than prescribed.
  • Finishing a prescription early.
  • Using someone else’s prescription drugs.
  • Mixing pain pills with other substances, like alcohol, illegal drugs, or other pharmaceuticals, whether prescribed or available over the counter.
  • “Doctor shopping” visiting multiple doctors and pharmacies — to obtain multiple prescriptions.

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Withdrawal symptoms

You should slowly taper off and stop use of prescription opioids under the care of a licensed medical provider, who can help you manage symptoms of withdrawal. Withdrawal symptoms include agitation and anxiety; cravings for the drugs; dehydration; hot and cold flashes and sweating; nausea and vomiting; tremors or shaking; watery eyes, runny nose, and sneezing; and yawning or restless sleep. Signs of an opioid overdose include slowed or stopped breathing.

Prescription opioids and the brain: Opioids enter the brain and cling to cellular proteins called opioid receptors, which are found in the brain and elsewhere in the body. Our brain’s opioid system is involved in behaviors related to mood, pain, reward, and impulsivity. Opioids stimulate the brain’s reward circuits and cause a surge in dopamine, a chemical messenger that can give us a pleasurable “high.” This high can also make us want to take more of the drug, increasing the likelihood of using it daily and becoming dependent.

Treatment for prescription opioid misuse

Recovery from opioid use disorder is possible. There are effective treatments to reduce the potential for relapse and manage withdrawal systems. Until you’re fully recovered from prescription opioid use disorder, carry naloxone, a nasal spray that can reverse opioid overdose; naloxone is available over the counter in most states.

Therapy: A licensed medical provider may recommend medication for addiction treatment (MAT), which combines the use of prescription drugs to alleviate withdrawal symptoms with therapies such as behavioral counseling. Studies have shown that MAT reduces opioid use and related deaths. Types of counseling to treat opioid use disorder include cognitive behavioral therapy; contingency management, which assigns “points” for negative drug tests; and motivational interviewing, which is a form of patient-focused counseling.

The Food and Drug Administration (FDA) has also authorized a mobile cognitive behavioral therapy app called reSET that can be used with MAT and other therapies; the app is available by prescription.

Medication: Specific FDA-approved opioid misuse treatments include buprenorphine (brand names include Suboxone and Subutex); methadone; and extended-release naltrexone (marketed as Vivitrol). The FDA has also approved the nonopioid treatments clonidine and lofexidine (sold under the brand names Catapres and Lucemyra, respectively) for managing opioid withdrawal. Use these medications with caution, as they can cause low blood pressure.

Recovery: Further manage your symptoms and promote your recovery by drinking a lot of water, getting plenty of exercise, and practicing relaxation techniques such as yoga and meditation.

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Sources

A Comparison of Long- and Short-Acting Opioids for the Treatment of Chronic Noncancer Pain: Tailoring Therapy to Meet Patient Needs, NIH National Library of Medicine, July 2009.

CDC Guideline for Prescribing Opioids for Chronic Pain, March 18, 2016

CDC Launches New Education Campaigns Aimed at Preventing Drug Overdose Deaths, News Release, Oct. 27, 2021

Fentanyl DrugFacts, National Institute on Drug Abuse, June 2021

Inside Fentanyl’s Mounting Death Toll: ‘This Is Poison’, The New York Times, November 22, 2021

Key Substance Use and Mental Health Indicators in the United States: Results from the 2020 National Survey on Drug Use and Health, October 2021

Opioid Use Disorder and the Brain: A Clinical Perspective, Addiction, 2021

Opioid withdrawal symptoms, Australian Government Department of Health, April 2021

Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use, National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Committee on Pain Management and Regulatory Strategies to Address Prescription Opioid Abuse; Washington (DC): National Academies Press (US); July 13, 2017

Policy Brief: Effective Treatments for Opioid Addiction, National Institute on Drug Abuse, November 2016.

Prescription Opioids, Centers for Disease Control and Prevention, August 29, 2017

Prescription Opioids DrugFacts, National Institute on Drug Abuse, June 2021

Prescription Opioids and Heroin Research Report, National Institute on Drug Abuse, undated

Prevent Opioid Misuse, Centers for Disease Control and Prevention, Nov. 20, 2020

Prevention of Opioid Overdose, New England Journal of Medicine, 2019

Rapid onset opioids in palliative medicine, Annals of Palliative Medicine, April 2012

Risk Factors for Opioid-Use Disorder and Overdose, Anesthesia & Analgesia: November 2017, Volume 125, Issue 5, pp. 1741-1748

Trends and Geographic Patterns in Drug and Synthetic Opioid Overdose Deaths — United States, 2013–2019, February 12, 2021 

U.S. Overdose Deaths In 2021 Increased Half as Much as in 2020 – But Are Still Up 15%, CDC, May 11, 2022