Pain relief Resources and Migraine Headache

What are opioids, and what is their place in medical practice?

Opioids are strong painkillers that are derived synthetically or naturally from opium. They are used to treat both short-term pain (following injury or surgery) and chronic pain conditions.

What should I know about deaths from prescription drugs?

The second leading cause of accidental death in this country is drug overdose. Many of these deaths involved opioids or other types of prescription drugs. Opioid poisoning now causes more deaths than either heroin or cocaine.

What factors are contributing to the increase in overdose deaths involving opioids?

Overdose deaths happen to different people for different reasons. Some people mistakenly believe that opioid medications are “safer” to misuse than street drugs. In fact, opioids are as dangerous as heroin when they are used to seek a high. Prescription drugs can be especially lethal when mixed with alcohol, anti-anxiety medication like Valium, street drugs, and some sleep medications.

Some people who died from opioid overdoses are patients with valid prescriptions for the medications. Patients who are not experiencing adequate pain relief may choose to take more medication than directed. This is very dangerous. If you are not getting enough pain relief from your current dosage, talk to your health care provider.

How addictive are opioid medications?

About four percent of people who take opioids for chronic pain will become addicted to them. Because addictive behaviors are difficult to control, addicted people are at high risk for drug overdose. Patients who become addicted to opioids generally show the following behaviors:

• Impaired control over drug use
• Compulsive use
• Continued use despite physical, mental or social harm
• Craving

It is important to note that most people who take opioids for pain will not become addicted. Those who do will need treatment for addiction.

Another risk factor for overdose could be sleep apnea. Patients at risk for sleep apnea should be evaluated before they are prescribed opioids. The addition of a Valium-like medication together with opioids appears to produce a greater risk of life-threatening sleep apnea.

How can I prevent misuse of the opioid medications I have been prescribed?

Take the responsibility to teach family members, especially young people, that opioids are not safe when used for unintended purposes or outside of the limits and instructions of a prescription. Government statistics show that many nonmedical users got their drugs from a friend or a relative. Unauthorized “sharing” or thefts from a medicine cabinet are frequent sources.

To prevent theft, always:

• Put medicines in a locked cabinet and store the key
• Do not store prescription drugs in a bathroom medicine cabinet (these rarely lock), the kitchen cabinet or a car glove compartment
• Do not store medicine bottles in nightstands, purses, coat pockets or other locations easily accessed by others
• Do not store medicines in the refrigerator unless so directed by your pharmacist

How can I prevent medication or dosage errors?

• Never take medicine in the dark. Always turn your lights on and wear reading glasses if needed.
• Read the label each time to check the dosage
• Examine the medicine before taking it, checking for capsules or tablets that differ from others in the bottle
• Follow directions carefully, including special instructions such as “Do not take with grapefruit” or “Take two hours before or after meals”
• Dispose of unidentified and out-of-date medications as instructed by your pharmacist
• Always tell your physician about all medications you are taking from any source

How can I protect my children and other family members?

• Use containers that separate each day’s dose so that an individual will not accidentally take a second dose because he or she forgot originally taking it
• Avoid taking medicines in front of children, because children like to imitate grown-ups
• Use child-resistant packaging when possible and replace caps securely after each use
• Never call medicine “candy.” Call it “medicine.”
• Do not discard medicines in the wastebasket where children can find them.
• When giving medicine to a family member, check the label each time you give it.
• Keep track of doses
• Never share medications with others
• If you suspect someone has stolen your prescription, report it to your local police department. You may save a life.

Why are teens at a higher risk for abuse of prescription pain relievers?

According to the Partnership Attitude Tracking Survey (PATS)*, teens in grades seven through 12 hold the following attitudes:

• About half of all teens do not see great risk in abusing prescription drugs
• A majority of teens agree prescription drugs are easier to get than illegal drugs
• Four of 10 believe they are much safer to use than illegal drugs – even if they weren’t prescribed by a doctor
• Roughly three of 10 agree there is nothing wrong with using prescription medicines once in a while and that prescription pain relievers are not addictive

Such surveys show that many teens hold dangerous views about prescription drugs. Furthermore, research shows that most teens obtain the drugs they abuse from family and friends – often stealing prescriptions from a medicine cabinet. It is important to talk to teens about drug abuse and to safeguard your own prescriptions to ensure they are not accessible to teenagers or others who visit your home.

*Completed in 2005 by 7,218 adolescents

What does the FDA say about methadone?

On November 26, 2007, the FDA issued an advisory warning of potential fatal outcomes associated with methadone. The agency warned that “prescribing methadone is complex” because its analgesia wears off long before it is cleared from the body. The announcement coincided with new prescribing guidelines, which lowered the maximum suggested initiation dosage from 80 mg to 30 mg per day.

Is methadone exceptionally risky to take? How is it different from other opioids?

Methadone deaths jumped 390% between 1999 and 2004. Even though it is not prescribed nearly as often as other types of drugs, methadone was responsible for 13% of drug-related deaths in 2004. One reason for its powerful effect may be the unique way the drug accumulates in the body. Methadone provides pain relief for only four to eight hours, but its effect on suppressing breathing may last for two to three days when a patient takes it for the first time. Patients need plenty of time to develop a tolerance to the breathing depressant effect of methadone. Any controlled substance can be hazardous when used outside of medical direction, but it is particularly important never to take more methadone than prescribed.

There also appears to be a small group of patients who converted from one opioid to methadone at a level that could be dangerous. This can occur when health care providers rely on a conversion table that suggests an equal dose of two opioids. When this happens, the starting dose of methadone could be high enough to stop respiration. If you have recently been switched to methadone, ask your provider how he or she determined the prescribed dosage.