The relief brought by opioid pain medications can make life much more comfortable for people recovering from surgery and as a treatment for severe back pain.

See Medications for Back Pain and Neck Pain

Every medication has benefits and drawbacks, however. The powerful effects of opioids call for special care to avoid or watch out for potential problems, including:

  • Accidental overdose
  • Dependence on medication
  • Side effects, including breathing problems
  • A need for increasingly stronger doses

See Opioids for Back Pain: Potential for Abuse, Assessment Tools, and Addiction Treatment

While all medications should be used as directed, this is especially important with opioids. Pain medication usually has a stronger effect on older adults, so extra caution is advised for older individuals.

In This Article:

Avoiding an Accidental Overdose

The U.S. Centers for Disease Control and Prevention has warned of an epidemic of fatal prescription opioid overdoses. A single, high-dose tablet can cause fatal breathing problems.

These precautions are advised to prevent an overdose:

  • Avoid taking a second medication that causes sleepiness, such as another opioid, anti-anxiety medication, or a muscle relaxer. Alcohol should be avoided as well.

    See Side Effects and Risks of Muscle Relaxers

  • Keep the doctor informed by providing a thorough medical history, including any addiction problems.
  • To be certain of the correct dose, liquid medication should be measured using the dropper provided, a marked dosing cup, oral syringe, or measuring spoon, rather than a spoon designed for the table. Spoons used for food vary in size.
  • Tablets and capsules must be swallowed whole, and not moistened, crushed, or cut. Doing so can allow the patient to ingest a dangerous amount of medication.
  • If a medication is not working, the doctor should be contacted. The dose should never be increased without a doctor’s approval.
  • Ask the doctor about interactions with food. Some foods, such as grapefruit or grapefruit juice, increase the amount of medication the body retains.

Signs of an overdose include blue lips and a weak pulse or heartbeat. Sometimes the person makes gurgling sounds. The individual should go immediately to an emergency room, where a fast-acting medication, called naloxone (Narcan), may be life-saving. Many first responders, including police officers and EMTs, carry this medication. In some states it is available over-the-counter, without a prescription.

Opioid Common Side Effects

The side effects of opioids tend to increase with higher doses. These are typical side effects:

  • Constipation
  • Dry mouth
  • Upset stomach
  • Lung and heart problems
  • Sleep apnea

The doctor should be informed of any side effects. In some cases, the doctor might suggest the patient switch to a different medication or suggest ways to avoid or minimize the side effects.

See Pain Management Specialists


Opioid Dependence and Withdrawal

Opioids are ideally taken for short-term pain relief, and addiction is unlikely with short-term use (e.g. up to one or two weeks). Individuals who take opioids over a longer period may become physically dependent on the medication, however.

See Pain Killer Addiction Treatment

Dependence should not be confused with addiction. Dependence is a physiological response. With addiction, however, there is not just the physical response to the medication but also a craving for the “high” it provides, and a desire to continue taking it no matter what kind of problems the medication causes in daily life.

See The Difference Between Opioid Addiction and Physical Dependence

Stopping the medication after long-term use must be done carefully to avoid withdrawal symptoms. Tapering off the medication gradually, in close consultation with the doctor, is best. Typical symptoms of withdrawal include fever, chills, and sweating. Withdrawal symptoms are more likely in those who have been using opioids at high doses.

See Opioid Detoxification and Withdrawal


Opioid Tolerance

As time goes on, the patient’s body will become more tolerant of the drug and require a higher dose to get the same pain relief as before. If an individual stays on the medication long enough, he or she may reach the stage where even high doses of the medication don’t ease the pain. The doctor may discuss non-opioid strategies to replace or supplement opioid medications.

In some situations, continuing to take opioids can actually make the individual feel pain from things that normally would not hurt.

Long-term use of opioids has certain side effects. The body’s tolerance for opioids can linger long after the medication is stopped. Individuals who have built up a tolerance may encounter difficulty getting pain relief if a new, unrelated source of pain occurs, such as a severe injury or surgery that would typically be treated with opioids.

Dr. Kathee de Falla is a licensed and certified pharmacist. She has more than a decade of experience providing medical advice and supplying prescription medications in a retail setting. Dr. de Falla spent several years developing drugs at Abbott Laboratories, a pharmaceutical company where she holds a patent for a drug formulation.