Opioid pain medications, also called narcotics, are the strongest pain relievers. They are used to treat moderate to severe pain. Opioids are prescribed for acute (short-lived) pain or chronic pain due to cancer and other medical problems. Opioids are usually started at low doses then gradually increased to achieve pain relief or until side effects are not tolerated.

How do opioids work?

Opioids are related to morphine and include medications such as codeine, hydromorphone, oxycodone and fentanyl. Opioids work on opioid receptors in the body, which are located in the brain, spinal cord, and intestines.

What are the side effects of opioids?

Activation of opioid receptors also causes side effects - nausea, constipation, drowsiness, and reduced breathing. With continued use, the body adapts to all of these side effects, except for constipation. Therefore, if you are taking an opioid pain medication, your doctor likely will recommend that you take a stool softener and a laxative to prevent and treat constipation. Talk to your doctor about a plan to prevent and manage constipation.

When opioid pain medication is started or the dose is increased, driving and other hazardous activities should be avoided until you no longer feel these effects. Many people taking opioids continue to drive, work, travel, and function much better than before because their pain is controlled. However, some people may not adjust to the opioid and find themselves feeling groggy. If you are having bothersome side effects from an opioid medication, contact your doctor or pharmacist. There are many strategies to deal with side effects (e.g., decreasing the dose of opioid, adding other pain medications, lifestyle measures, or medications).

Taking opioids

When possible, opioid pain medications are given in tablet or liquid form. However, opioids are also available as patches, injections, and suppositories when tablets or liquids cannot be used.

Some opioids are available as short-acting tablets, long-acting tablets, patches, suppositories, and injections. Short-acting preparations are ideal for acute pain and for starting opioid therapy. Long-acting preparations are preferred for the treatment of severe chronic pain and after a daily dose is established with short-acting opioids. For chronic pain, short-acting opioids may continue to be used for pain that is not controlled by the long-acting opioid. This pain is called breakthrough pain.

I have concerns about opioids. Will I get addicted?

Opioid pain medications are also associated with tolerance, physical dependence, and addiction.

Tolerance occurs when you require higher doses of an opioid to achieve the same pain control. It is not the same as addiction. With tolerance, your dose of pain medication may not work as long as it used to or may not work as well. Tolerance to the pain-reducing effects does not happen with everyone.  

Physical dependence also occurs with opioid pain medications. This means that if you stop taking opioids suddenly, you will likely experience withdrawal symptoms. Withdrawal symptoms can include headaches, sweating, goose bumps, diarrhea, stomach cramps, fast heartbeat, anxiety, agitation, and hallucinations (hearing, seeing, or feeling things that are not there). Physical dependence is not the same as addiction and can be managed by reducing the dose of the opioid gradually as directed by your doctor.

Addiction to opioid pain medication does not happen very often when opioids are used to treat pain. Addiction is characterized by a compulsive, uncontrollable need or craving for the medication and uncontrolled use of the medication even though the medication is causing harm. Various inherited and psychological factors influence the development of addiction. True addiction is not common, but if you or someone in your family has misused medications, illegal drugs or alcohol in the past, or if you have severe anxiety or depression, you may be more likely to develop an addiction to opioids.

Other fears

When used as a recreational drug (not being taken under medical supervision on a regular basis for pain), a large dose of opioids may reduce breathing to the point of causing death. This may make you fearful of taking opioids. Fortunately, when opioids are taken under the supervision of a doctor, reduced breathing rarely occurs. Some people also believe that morphine used for pain leads to an earlier death. There is no research to support this. In fact, studies have shown that pain relief leads to a better quality of life and preliminary research shows it may lead to a longer life.

When treating most chronic pain and cancer pain, a regular dose of an opioid is given. For cancer pain, the dose of opioid often needs to increase as the disease progresses. People often worry that a higher dose means that the medication is losing its effectiveness or that they will become addicted - this is not the case. The dose needed to control the pain is the dose that should be taken, and it will vary widely from person to person. Many people will take opioids for years, and if the cause of their pain remains stable, their dose of opioid remains stable as well.