Have you ever been in a serious accident or had to undergo major surgery? Your doctor may have prescribed you a very strong painkiller to help with the unbearable pain you were feeling. These painkillers are also used to treat chronic, severe pain conditions like cancer. Today we are going to talk about this powerful class of painkillers, called opioids. Although they provide wonderful pain relief, it is important for us all to be aware of the other side of the coin and the risks they pose.
Simply put, what are these Opioids?
Opioids are a special class of drugs used to treat moderate to severe pain. They are sometimes called "narcotics." Some of these opioids are produced naturally (for example , from the poppy plant), while others are made synthetically in a laboratory.
These work in a very strange way. Imagine, when you get injured somewhere in your body, a message goes from that place through the nerves to the brain saying, "This is pain." What opioids do is they affect the nerve cells that carry that message, and they stop that message from going to the brain. It's like they're blocking the message. So you don't feel the pain until the drug takes effect.
However, these drugs do something else. They stimulate the reward system in our brains, which is why some people can experience a feeling of great happiness, lightness, and a sense of floating (euphoria) when they take these drugs.
This is why the risk of addiction to opioids is so high. Even if you want to stop taking the drug, your brain won't let you. It keeps asking for that happy feeling. Over time, you can become mentally and physically dependent on the drug.
Another problem is that over time, the body becomes accustomed to this drug (tolerance). This means that the pain relief obtained from the initial dose is no longer sufficient. To get the same relief, the dose of the drug must be gradually increased. This situation increases the risk of a dangerous overdose.
Because of this high risk of addiction, if a doctor prescribes an opioid for you, they will do so very carefully. They will monitor you closely and gradually taper the dose to minimize withdrawal symptoms.
What are the main types of opioids?
There are over a hundred types of opioids. They can be divided into three main groups based on how they are produced:
- Natural: These are made from substances extracted from the seeds of the poppy plant. These are also called Opiates. (Example: Morphine, Codeine).
- Semi-synthetic: These are made by modifying natural opioids in a laboratory (e.g., heroin, hydrocodone).
- Synthetic: These are made entirely in a laboratory without any natural ingredients (e.g. Fentanyl).
The table below shows some of the most commonly used and discussed opioids.
| Opioid drug name | A brief introduction |
|---|---|
| Codeine | It is usually given for mild to moderate pain and to control some types of cough. |
| Morphine | It is widely used for severe pain, especially after surgery and for cancer pain. |
| Oxycodone | Another powerful medication for moderate to severe pain. |
| Fentanyl | It is a drug that is 50-100 times more powerful than morphine and is given under medical supervision only for very severe pain. |
| Methadone | It is also used as a painkiller and to treat people addicted to other opioids (especially heroin). |
| Heroin | This is an illegal drug that is not available on medical prescription. It has a very high potential for addiction. |
In what situations do doctors prescribe opioids?
A doctor wouldn't prescribe such a powerful medication for nothing. They're only prescribed for severe pain that can't be controlled by other painkillers.
- Acute pain: Short-term, severe pain that occurs after a serious accident, fracture, or major surgery.
- Cancer-related pain: Manage severe and long-term pain in cancer patients.
- Chronic pain: In some cases, for long-term pain that cannot be controlled by other treatments.
- Palliative care: To reduce the pain and discomfort of a patient with an incurable illness and help them remain comfortable.
These opioids come in various forms, such as tablets/capsules, oral solutions, injections, and suppositories.
What are some things you should not use with opioids?
This is very important. If you are taking opioids, it is important to tell your doctor about all the other medications you are taking, including vitamins and herbal products. Also, be honest about any other substances you are taking, such as alcohol. Some of these can have unimaginably dangerous effects when combined with opioids.
Below are some things that can interact negatively with opioids.
| Interactable material | Possible risk |
|---|---|
| Alcohol | Severe drowsiness, loss of consciousness, very slow or stopped breathing, and even death can occur. Never drink alcohol with opioids. |
| Benzodiazepines and sleeping pills | This is just as dangerous as alcohol. It causes difficulty breathing and extreme drowsiness. |
| Muscle relaxants | Increases drowsiness and dizziness. |
| Some antibiotics and antifungals | These can dangerously increase opioid levels in the body. |
| Some anti-seizure medications | May reduce the pain-relieving effect of opioids or increase side effects. |
What are the side effects and complications of opioids?
Like any medication, opioids have side effects. Some are minor, while others can be very dangerous.
| Side effects and serious complications of opioid use | |
|---|---|
| Common side effects | |
| Drowsiness and slowness | Slowed thinking and action. |
| Nausea and vomiting | It is especially common when you first start using the drug. |
| Constipation | This is a very common side effect because it reduces bowel function. |
| Dizziness (vertigo) | The body's balance may be affected. |
| Serious complications to watch out for | |
| Overdose | This is a medical emergency. Symptoms include very shallow breathing, a slow heartbeat, and loss of consciousness. You should be taken to a hospital's Emergency Treatment Unit (ETU) immediately. |
| Physical Dependence | Withdrawal symptoms such as sweating, body aches, and restlessness occur when the medication is stopped or the dosage is reduced . |
| Respiratory Depression | The lungs may not be able to get enough air. Carbon dioxide levels in the blood may increase. |
| Tolerance | Over time, a higher dose is needed to achieve the same pain relief. |
If you suspect that someone, especially a young child, has accidentally ingested one of these drugs, it is an emergency. Call the National Poisons Information Center at the Colombo National Hospital for advice while you are taking them to a hospital immediately.
What happens if you take Opioids long-term?
Long-term use of opioids can cause many other problems.
- Chronic constipation
- Weakened immune system
- Depression
- Increased risk of heart attack
- Very high risk of addiction and overdose
- Sexual dysfunction and decreased desire
- Sleep-related problems
- Opioid-induced hyperalgesia: This is a bit of a strange thing. When you take pain medication, the body's pain sensitivity increases because of the medication. This means that even mild pain starts to feel much more intense.
Opioids are a very powerful and helpful class of drugs. But they should only be used under the supervision of a doctor, in the right dosage, and for the right amount of time. If you think you are becoming addicted to these drugs, or that they are affecting your life, don't be ashamed or afraid. Talk to your doctor about it right away. There are ways to get help.
Take-Home Message
- Opioids are a type of very strong painkiller that is prescribed only for severe pain.
- The risk of addiction to these is very high. Therefore, never use more than the dose prescribed by your doctor or for longer than the prescribed period.
- Do not give your prescribed opioids to anyone else for any reason. It could be life-threatening.
- If you are taking opioids, be honest with your doctor about all other medications, alcohol, and other substances you use.
- If you feel dependent or addicted to the drug, don't be shy and talk to your doctor and seek help.
- If you notice signs of overdose, such as difficulty breathing, extreme drowsiness, or loss of consciousness, consider it an emergency and immediately take the patient to a hospital's Emergency Treatment Unit (ETU).
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