Talking to your health care provider about opioids

You may be prescribed an opioid to help manage your pain. Opioids are medications prescribed to treat pain that may have been caused by certain injuries or illnesses. While opioids may not take your pain away completely, they are legitimate medications to be considered as part of your overall pain management strategy.

As with all medications, opioids can have risks and potentially dangerous side effects. If you are prescribed an opioid, it is important to have a conversation with your health care provider – such as your physician, surgeon, nurse practitioner, or sport medicine doctor – to determine if this medication is appropriate for you, and how to use them in the safest way possible.

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About opioids

Opioids are medications that are primarily used to treat pain. When taken properly, prescription opioids can help pain patients manage their condition, allowing them to lead full and productive lives. Examples of prescription opioids include:

  • fentanyl
  • morphine
  • oxycodone
  • hydromorphone
  • methadone
  • buprenorphine/naloxone

Some of the medications on the list above (i.e., methadone, buprenorphine/naloxone, hydromorphone) are also sometimes used to treat opioid use disorder ("addiction").

When being prescribed an opioid

You should always follow the instructions given to you by your health care provider, use the lowest dose of opioids possible to control your pain, and take the medication for the shortest amount of time possible. If you are on opioids for an extended period of time (e.g., 1-2 weeks), make sure that you are regularly checking in with your health care provider to discuss how the medication is addressing your pain management needs.

It is also important to have discussions with your health care provider about the appropriate dose of opioids to treat your condition and how long you need to take them. When starting an opioid therapy, you should also discuss whether you need to create a plan for when you stop taking this medication, to avoid withdrawal due to abrupt cessation.

Side effects

The short-term side effects of using opioids may include:

  • drowsiness
  • constipation
  • impotence in men
  • nausea and vomiting
  • euphoria (feeling "high")
  • difficulty breathing, which can lead to or worsen sleep apnea
  • headaches, dizziness and confusion, which can lead to falls and fractures

The longer-term side effects of using opioids may include:

  • increased tolerance (i.e., requiring higher doses of the medication to produce the desired effect)
  • substance use disorder or dependence
  • liver damage
  • infertility in women
  • worsening pain (known as "opioid-induced hyperalgesia")
  • life-threatening withdrawal symptoms in babies born to mothers taking opioids

Risks

Physical dependence

Continuous use of opioids, including for medical purposes, may lead to physical dependence. This is a natural reaction that may occur in the body when using opioids, particularly when using for an extended period of time (e.g., 1-2 weeks). Physical dependence is different from substance use disorder. If opioid use is suddenly stopped, a person may experience symptoms of withdrawal. This may include:

  • restless sleep
  • heavy sweating
  • chills
  • shakiness
  • increased pain
  • twitching, aching muscles

If you are considering reducing or stopping your opioid medication, it is important to discuss strategies with your health care provider to do so in a safe and effective manner. If you have been on high doses of opioids, or if you have been taking opioids for an extended period of time, you will need to come off opioids slowly and this process may take several weeks/months.    

Problematic use/ Substance use disorder ("addiction")

Opioids can produce euphoria (feeling "high"), increase one's sense of wellbeing, and/or reduce anxiety. These are examples of factors that may lead some individuals to engage in problematic opioid use.  

When people think about problematic opioid use, they often think about when someone takes an illegally produced or obtained opioid.

Problematic opioid use also includes:

  • using an opioid medicine improperly, such as taking more than is prescribed or taking it at the wrong time; or
  • using an opioid medicine that was not prescribed for you.

You should be notifying your health care provider if you have a history of problematic alcohol or drug use, or if you start using opioids problematically.

Overdose

Opioid medications affect the part of your brain that controls your breathing. When you take more opioids than your body can handle (overdose), your breathing slows. This can lead to unconsciousness and even death.

It is important to take your medications as prescribed. Opioids should not be used in combination with alcohol. When using opioids with other medications, you should first consult your health care provider.

Stop taking the medication and get immediate help if you experience any of the following:

  • severe dizziness
  • inability to stay awake
  • hallucinations
  • heavy or unusual snoring
  • slow breathing rate

Learn the signs and symptoms of an overdose. If you are taking high doses of opioids or certain other medications that may increase the risk of experiencing an overdose (e.g., muscle relaxant, sedative, sleep medication), you may wish to have a naloxone kit on hand. This can temporarily reverse an overdose. Naloxone kits are available without a prescription at pharmacies. Ask your pharmacist.

Other treatment options

It is important to discuss with your health care provider how to best control your pain, particularly if you expect your pain could last for more than 1-2 weeks. Opioids may not be the best treatment option for your pain. Other treatment options that do not use opioids or other medication may help you manage your pain. While the availability of some treatment options may vary depending on where you live, it is important that you discuss these with your health care provider to find out what options may be available and appropriate for you. Ultimately, treatment decisions should be made between you and your health care provider.

Questions to ask your health care provider

Any time you get a new prescription opioid medication you should make sure you understand why you are taking it and the instructions on how to take it safely.

Ask your health care provider if you don't know the answer to the following questions:

  • Why am I being prescribed this medication?
  • What are the benefits of this medication?
  • When can I expect to feel better?
  • How much pain relief should I expect from this medication?
  • How long should I be taking this medication?
  • What dose should I take and how often?
  • Are there any alternatives to opioids I could take?
  • What are the risks and potential side effects of taking opioids?
  • Is there a risk of substance use disorder ("addiction")?
  • How can I reduce the risks?
  • What if I have a history of substance use disorder ("addiction")?
  • Are there any interactions with other medications that I am taking?
  • What should I do if the medication is not working?
  • When should I return for a follow-up appointment to assess the benefits and potential harms of this therapy?
  • What is the plan if I feel better and no longer need to take opioids?

Things to tell your health care provider

To advise you properly, your health care provider needs all of the facts. This is the information you should share:

  • your complete medical history
  • any concerns you have about taking an opioid
  • if you are pregnant or planning to have a baby
  • if you are a smoker
  • if you are taking other medications, particularly to treat:
    • anxiety
    • seizures
    • sleeping problems
  • if you are undertaking other therapies or strategies to manage your pain
  • if you have a history of
    • problematic alcohol or drug use
    • previous or current substance use disorders
    • major depressive disorder
    • generalized anxiety disorder

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