Many patients think that taking a drug as prescribed by a doctor is completely safe, so they do not ask their practitioner any questions about their medications. It is always important to know as much as you can about the medications you take, of course, so that you can get the most out of your medication and avoid any problems. Learning about prescription drugs is especially important when it comes to opioids, which are a type of prescription pain medication at the center of a national crisis.
Opioids are drugs that act on the central nervous system in ways that suppress pain signals to the brain, which make them the drug of choice for the treatment of pain from a serious illness or injury, or after surgery. Opioids also cause a pleasant euphoric feeling, which make them a target for recreational use.
Using opioids for more than a few days can lead to opioid misuse and abuse, addiction, physical dependence, overdose and death. Opioid abuse and overdoses have reached epidemic proportions. In 2016, more than 2 million people had an opioid use disorder, according to the U.S. Department of Health and Human Services (HHS). More than 42,000 people died from opioid overdose that year, which is more than in any previous year on record.
Women bear a greater burden of the opioid epidemic, according to a 2017 report by the HHS’s Office on Women’s Health. The authors of that report found that the death rate from prescription opioid overdoses jumped an astonishing 471 percent among women between 1999 and 2015, compared to an increase of 218 percent among men. Deaths related to synthetic opioid overdoses skyrocketed 850 percent in women during those years.
Medical scientists are still working to understand how opioid use and misuse might affect women differently than the drugs affect men.
A study by QuintilesIMS Institute found that doctors prescribed opioids to women ages 40 to 59 more than to any other age group, and that doctors were twice as likely to prescribe opioids to women as to males of that age. The women in this age group were also more likely to become persistent users after undergoing a surgical procedure, with 13 percent of women in this age group continuing to use opioids long after undergoing their procedure. This is especially worrisome, as women 45 and 54 years old have the highest opioid overdose death rate among all females.
That study also showed that nearly 3 million male and female patients who had surgery in 2016 became persistent opioid users, which means they continued using the drugs for three to six months following their procedures.
7 Questions You Should Ask Your Doctor before You Take an Opioid
1. Is this medication an opioid?
Drug names are confusing, even for medical professionals. In fact, drug names are so confusing that the Institute for Safe Medication Practices made up a new naming system to reduce the risk of errors. This system, known as tall-man lettering, writes part of a drug’s name in upper case letters to distinguish it from sound-alike drugs.
2. Is this safe to take with my other medications?
Opioids can interaction with other drugs in dangerous ways. These drugs include:
- Alcohol
- Anti-seizure medications, such as carbamazepine, also known as the brand name Carbatrol and Tegretol
- Benzodiazepine, which is a class of drug used to treat anxiety, depression, and insomnia
- Some antibiotics, including clarithromycin
- Certain antidepressants
- Some antifungals
- Certain medications used for HIV infection
- Drugs for sleeping problems, such as zolpidem, known by its brand names Ambien, Intermezzo, and others
- Medications that treat psychiatric disorders, such as Haldol
- Muscle relaxers, such as cyclobenzaprine (Amrix)
- Other opioid medications
Bring a list of all the prescription and over-the-counter medications you take, including any other types of prescription pain medication you may take. Better still, bring your medications with you. Be sure to include any supplements or herbal remedies.
3. Is there another non-opioid prescription pain medication I could take instead?
You might be surprised to learn that some of your favorite go-to over-the-counter medications are available in prescription strength. Ask your doctor if you can take prescription non-steroidal anti-inflammatory drugs (NSAIDs), such diclofenac (Voltaren) and celecoxib (Celebrex). While these prescription drugs may produce more side effects than their non-prescription counterparts, they do not lead to dependence or addiction.
4. Is this the lowest dose possible?
At the proper dose, opioids can effectively relieve pain. Taking a higher dose than necessary can lead to a number of health problems, including dependence, addiction, and even overdose or death.
To avoid these problems, start with the lowest dose possible and then ask your doctor to increase the dosage as necessary to control your pain.
5. May I have fewer pills?
The longer you take opioids, the greater your risk for developing a drug problem. In fact, a study published by the Centers for Disease Control and Prevention (CDC) showed that opioid dependency starts within just a few days – just after five days of use in many cases.
Ask your doctor to prescribe fewer pills and try to take opioids for the shortest amount of time possible – you can always ask your doctor to refill your prescription if you continue to have pain after you have finished your first bottle of pills.
Doctors want to relieve pain – it is what doctors do. Some doctors tend to overprescribe, though, by giving their patients too many painkillers.
Overprescribing leads to misuse and diversion of leftover pills to the black market. The study by QuintilesIMS Institute found that overprescribing by doctors left 3.3 billion opioid pills unused by patients, making those pills available for misuse.
6. How should I stop taking opioids?
If you have taken prescription opioids every day for several days in a row, you may have developed physical dependence on opioids. This means your body has acclimated to the presence of opioids, and that you have to take a certain amount of opioids every day for your body to feel “normal.” If you are physically dependent on opioids and try to quit suddenly, you may experience unpleasant withdrawal symptoms. These withdrawal symptoms can include muscle pain, nausea and vomiting, diarrhea, restlessness, sweating, and anxiety.
To avoid experiencing withdrawal symptoms, gradually reduce the amount of opioids you take every day. If you have difficulty reducing your dosage gradually, talk to your doctor.
7. Should I have naloxone?
Naloxone, also known by the brand name Narcan, quickly reverses the effects of opioids during a drug overdose. The Substance Abuse and Mental Health Services Administration (SAMHSA) says that naloxone should be available to those patients at high risk for overdose. These patients include those that take high doses of opioids to manage long-term pain, or take certain extended-release or long-acting opioid medications. SAMHSA also says that someone on a rotating medication regimen, where he or she periodically switches to a different type of opioid, should have naloxone available.
Patients can use an automatic injection device or nasal spray to administer naloxone to themselves; family members and caregivers can administer an intravenous dose of naloxone every two to three minutes in an overdose emergency.
If you are at high risk for overdose, speak with your doctor about a prescription for naloxone. Your doctor or pharmacist should show you and your family members or caregivers how to administer naloxone.
Before you take an opioid, talk with your doctor or other health care professional. The more you know about the opioid medications you take, the better you can protect yourself from becoming part of the opioid epidemic.
