Opioids (sometimes called narcotics) are a class of drugs that are chemicals — natural or synthetic — that interact with nerve cells that have the potential to reduce pain. Healthcare providers typically prescribe opioids to manage moderate to severe pain.

 

However, opioids can become addictive because they not only dull pain, but also produce a sense of euphoria. This, combined with tolerance build (needing to increase doses to produce the same effect) can lead to opioid use disorder. Because of this, providers have modified their prescribing practices to reduce the length and strength of opioids to try to prevent addiction.

 

Prescription opioids are approved for managing moderate to severe pain. This can include:

 

The U.S. Food and Drug Administration (FDA) has also approved the use of some opioids to treat intense coughing and chronic diarrhea. Loperamide is an opioid healthcare providers use to treat diarrhea and irritable bowel syndrome (IBS). Opioids such as codeine and dextromethorphan are useful as cough suppressants.

 

“Opioid” is an umbrella term that represents all compounds that bind to opioid receptors. Opioid receptors are found throughout your central and peripheral nervous systems, as well as in your gastrointestinal (GI) tract. These receptors regulate many body functions, including:

 

Once activated, opioid receptors initiate a cascade of chemical reactions that ultimately modulate the transmission of pain signals. Opioids also cause neurons that produce dopamine, the neurotransmitter that plays a role in how we feel pleasure, to fire more frequently. This creates feelings of euphoria (intense happiness).

 

Some opioids are used to stop diarrhea by slowing gastric motility — the process by which food travels through your digestive tract via a series of muscular contractions. This allows more time for absorption of the food in your system.

 

You should always be careful when taking any prescribed medication, but you need to take extra care when taking prescribed opioids. Helpful tips include:

 

Take your medication exactly as prescribed by your healthcare provider — do not take extra doses.

If you can, use the same pharmacy for all of your medications. The pharmacys computer system will alert the pharmacist if you are taking two or more medicines that could cause a dangerous interaction.

If you feel that you are dependent on opioids or your prescribed dosage is not helping you manage your symptoms, do not take more than your recommended dosage and talk with your healthcare provider immediately.

 

Never share your opioid medication with someone else or sell your medication. Always store it in a safe place away from children and pets.

 

What are the side effects of opioids?

Common side effects of opioids include:

 

Physical dependence. This often manifests with withdrawal symptoms when opioids are discontinued or decreased.

Tolerance. As you take repeated doses of opioids, you require increased medication to experience the same effect of pain relief.

Respiratory depression. This can occur in healthy people, especially with higher doses. However, people with COPD, asthma or other lung conditions may be even more susceptible to fatal respiratory impairment.

Uncommon side effects of opioids include:

 

An increased sensitivity to feeling pain and extreme response to pain (hyperalgesia). Chronic use of opioids can lead to this.

Delayed gastric emptying (the process by which the contents of your stomach are moved into your small intestine).

Muscle rigidity.

Immune system and hormonal dysfunction.

Quick, involuntary muscle jerks (myoclonus).

Arrhythmia.

Itchy skin (pruritus).

Dry mouth (xerostomia).

What are the long-term effects of opioids?

Long-term side effects from chronic opioid use include:

 

Chronic constipation.

Sleep-disordered breathing (SDB).

Increased risk of bone fractures.

Hypothalamic-pituitary-adrenal dysregulation.

Increased risk of overdose.

What is known about opioids and overdose?

An overdose happens when too much of a drug is taken and harms your body. When too many opioids are taken, your breathing can slow and stop. Opioid overdoses can be nonfatal or they can result in death. People who have opioid use disorder are more likely to experience an overdose.

 

If you take opioids exactly as prescribed by your provider, it is very unlikely that you will experience an opioid overdose.

 

An opioid overdose can happen for a variety of reasons, including if you:

 

Take an opioid to get high.

Take an extra dose of a prescription opioid or take it too often (either accidentally or on purpose).

Mix an opioid with other medications, illegal drugs or alcohol. An overdose can be fatal when mixing an opioid and benzodiazepines — medications prescribed to treat anxiety and insomnia. Common benzodiazepines include diazepam (Valium®), alprazolam (Xanax®) and clonazepam (Klonopin®).

Take an opioid medication that was prescribed for someone else. Children are especially at risk of an accidental overdose if they take medication not intended for them.

Immediate action is needed to help someone experiencing an opioid overdose. Naloxone (commonly known by the brand name Narcan®) is a drug that treats the overdose immediately. Naloxone can reverse the effects of an opioid overdose if it is given to the person quickly. Medical attention is still urgently needed after naloxone is administered.

 

In 2019, nearly 50,000 people in the United States died from opioid-involved overdoses. The misuse of and addiction to opioids — including prescription opioids, heroin and synthetic opioids such as fentanyl — is a serious national crisis that affects public health. It is often referred to as the opioid epidemic or opioid crisis.