Opioids are a class of drugs used to reduce moderate-to-severe pain by binding receptors in the brain. Typically used to ease cancer pain for end-of-life patients, the past two decades have shown a dramatic increase in the use of prescription opioids for treatment of chronic pain despite serious risks and lack of evidence about long-term effectiveness. Opioids are also commonly used for short term pain relief after surgery, though there is minimal risk for addiction to occur if taken as prescribed.

You might be prescribed the following opioids, including:

• Natural opioids:
  • morphine
  • codeine
• Semi-synthetic opioids:
  • oxycodone (OxyContin®)
  • hydrocodone (Vicodin®, Percocet®)
  • hydromorphone
  • oxymorphone
• Fully-synthetic opioids:
  • tramadol
  • methadone
  • fentanyl (Abstral®, Actiq®, Fentora®, and Onsolis®).

Physicians who consider opioids for their patients have to outweigh the risks and benefits associated with their use. They might consider the state of a patient’s mental health or any past history of substance abuse before prescribing them. If a physician decides that prescribing opioids is the best course of action, the CDC recommends their use along with a mix of non-opioid medications and drug-free alternatives.¹

Some of these alternatives can include: 

• Non-steroidal, anti-inflammatory drugs (NSAIDS) including ibuprofen (Advil, Motrin) are one of the most commonly used drugs to not only relieve pain, but also lower fever and reduce swelling. NSAIDS can be just as effective as opioids for treating pain. One study found that patients who took NSAIDS reported lower pain scores and fewer side effects than those who took codeine.² Another study that examined the best form of chronic pain treatment also concluded that opioids were no better than NSAIDS for long-term pain management.³
• Acetaminophen (Tylenol) is another popular non-opioid pain reliever that may provide similar relief by itself or with a combination of ibuprofen. 
• Physical therapy (PT) is a suitable, drug-free method that has you work with a physical therapist to find the root cause of your pain. Of course, PT requires patients to put work into a daily routine for the best results. Patients aren’t going to see improvements overnight, and the outcome depends on the effort that’s put into their exercises. However, with PT patients aren’t at risk for addiction to opioids or dependence on any other medications that help alleviate pain.
• Massage Therapy is another form of PT that involves adding pressure to areas of your body that cause pain, soothing areas of stress and tension.

Here are some things to remember before taking opioids for the first time:

Take as directed. Depending on how long you take these medications, your dosage will change over time. Only take opioids under direct supervision from your doctor and don’t stray from the plan they made for you. Abuse and/or overdose may occur if you don’t take opioids exactly as prescribed.

Opioids shouldn’t be your only method for pain relief. Opioids, like other pain relievers, only mask the pain that people feel. They shouldn’t be used solely for pain treatment. Patients may find it beneficial to combine PT, massage therapy, or general exercise for the best results.

Opioids can cause side effects. Like with any drug, opioids come with short and long-term side effects which can include constipation, drowsiness, nausea, respiratory depression, and more. One of their most dangerous side effects is the sense of euphoria that patients get when taking the drug, which can often lead to misuse. 

Opioids work differently from one another. Depending on what they’re prescribed for, your doctor may give you extended-release pills (when the effects take some time to work) or immediate-release pills (when the effect of the medication can work almost as soon as you take it). Remember that your medication was prescribed for you and for you only, which is why it’s dangerous to buy opioids off the street or give them to someone else.

¹ CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016 | MMWR 
² Managing postoperative pain in adult outpatients: a systematic review and meta-analysis comparing codeine with NSAIDs | CMAJ 
³ Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial | Emergency Medicine | JAMA | JAMA Network