Using Opioids Safely

Adverse events are harmful or negative side effects associated with a medication.1 Adverse events from opioids are most commonly nausea and constipation.2 Your doctor may prescribe antiemetics, stool softeners, or laxatives along with the opioid medication.2 Other less common ones include vomiting, drowsiness, and respiratory depression.2 Uncommon side effects can include hypersensitivity to pain, delayed gastric emptying, and muscle rigidity.3 Prior to starting opioids, your doctor will discuss all of these risks, and discuss any contraindications based on your medical history and current health.4 Contraindications are symptoms, conditions, or other medications that could be harmful when taking a drug. If you are currently taking any prescribed medications, or if there are any conditions or medications that are not listed on your medical chart, it is important to bring these up with your doctor before starting an opioid.5

Some medications and substances are contraindicated with opioids and can have harmful effects and can even be fatal when combined with opioid use.7 This is especially true for sedative substances, such as benzodiazepines, or alcohol.8

Safely discontinuing opioid medications

You should never stop an opioid abruptly even if you are experiencing negative side effects or if the pain has resolved. Discontinuing opioids suddenly can lead to severe withdrawal effects.9 If you wish to discontinue use, your doctor may recommend an alternate medication to switch to, or discuss plans to taper the medication.10,11 Tapering refers to a slow reduction in doses and/or increase in time between doses until you can safely stop use.11 Your doctor may also consider tapering the opioid for several other reasons, including concerns around mental health or misuse, side effects, unrelieved pain, diagnosis of another medical condition, or simply due to prolonged opioid use.12

Proper storage and disposal

You should never share an opioid prescription with anyone else, or use another opioid prescription, even if it is from a family member or loved one, or someone with the same type of pain or condition.13 People can react to opioids in very different ways, and sharing prescriptions can cause harm or even an overdose. Similarly, you should never use anyone else’s opioid prescription. Opioids should always be stored in a safe location in your home out of reach from any young children.14

Unused, expired, or unneeded opioid prescriptions should be safely disposed of.16 Pharmacies, hospitals, police departments, and clinics often have drop boxes or take back sites where you can deposit opioids. It is recommended to remove all identifying information from the prescription before disposal. Your doctor can provide a list of nearby disposal sites or take back programs.16

References

  1. Agency for Healthcare Research and Quality (AHRQ). Medication errors and adverse drug events. September 7, 2019. https://psnet.ahrq.gov/primer/medication-errors-and-adverse-drug-events
  2. Swegle JM, Logemann C. Management of common opioid-induced adverse effects. Am Fam Physician. 2006;74:1347-1354.
  3. McNicol E, et al. Management of opioid side effects in cancer-related and chronic noncancer pain: A systematic review. J Pain. 2003;4:231-256.
  4. Centers for Disease Control and Prevention (CDC). Working together with your doctor to manage your pain. May 7,2024 https://www.cdc.gov/overdose-prevention/manage-treat-pain/manage-pain-with-doctor.html
  5. Cohen B, Ruth LJ, Preuss CV.. Opioid Analgesics. StatPearls. Last updated April 29, 2023. https://www.ncbi.nlm.nih.gov/books/NBK459161/
  6. Wanderer JP, Nathan NJ. Opioids and adverse effects: More than just opium dreams. Anesth Analg.2016;123:805.
  7. Cleveland Clinic. Opioids. Last reviewed May 27, 2022. https://my.clevelandclinic.org/health/drugs/21127-opioids
  8. National Institute on Drug Abuse (NIDA). Benzodiazepines and Opioids. November 7, 2022. https://nida.nih.gov/research-topics/opioids/benzodiazepines-opioids
  9. US Food and Drug Administration (FDA). FDA identifies harm reported from sudden discontinuation of opioid pain medicines. April 9, 2019. https://www.fda.gov/drugs/drug-safety-and-availability/fda-identifies-harm-reported-sudden-discontinuation-opioid-pain-medicines-and-requires-label-changes
  10. Fine PG, Portenoy RK. Establishing “best practices” for opioid rotation: Conclusions of an expert panel. J Pain Symptom Manage. 2009;38:418-425.
  11. Hospital for Special Surgery (HSS). A Patient’s Guide to Opioid Tapering. Last reviewed June 26, 2023. https://www.hss.edu/conditions_patient-guide-opioid-tapering.asp
  12. US Department of Veteran Affairs. Opioid Taper Decision Tool. October 2016. https://www.pbm.va.gov/PBM/AcademicDetailingService/Documents/Pain_Opioid_Taper_Tool_IB_10_939_P96820.pdf
  13. Ford JA, et al. Friends and relatives as sources of prescription opioids for misuse among young adults: The significance of physician source and race/ethnic differences. Subst Abus. 2020;41:93-100.
  14. American Academy of Orthopaedic Surgeons. Safe Use, Storage, and Disposal of Opioid Medications. https://www.aaos.org/quality/quality-programs/quality-toolkits/safe-use-storage-and-disposal-of-opioid-medications/
  15. Mississippi State University (MSU). Prescription Opioid Misuse. Last updated August 26, 2024. https://extension.msstate.edu/health/the-promise-initiative/prescription-opioid-misuse
  16. US Food and Drug Administration (FDA). Disposal of Unused Medicines: What You Should Know. October 1, 2020. https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know

All URLs accessed August 23, 2024.

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