Frequently asked questions about Opioid treatment for longterm

Frequently asked questions about Opioid treatment for longterm
pain
What are opioids?
Opioids (often called narcotics) are drugs that
are used mainly to help pain.
Examples of opioids are:
morphine
hydromorphine (also called Dilaudid ® )
oxycodone (also called Percocet ® .
*Note: Percocet ® also has acetaminophen
in it)
hydrocodone (also called Vicodin ® or
Lortab ® )
codeine
fentanyl (when in patch it is called
Duragesic ® patch)
meperidine (also called Demerol ® )
methadone
The many opioids work in different ways –
some last longer than others and some are
stronger than others. One opioid may work
better for one person and another opioid may
work better for some other person.
How can opioids help me?
Opioids are used mainly to help pain. How
well they work depends on many things.
Opioids work better for some kinds of pain
than others. For some types of pain, they do
not work very well.
Opioids can also sometimes be used to help
with coughing, diarrhea, and shortness of
breath.
What are the laws about using
opioids?
The government considers opioids a
controlled substance. This means there are
many laws about using opioids. Some of the
Massachusetts laws about opioids are:
© Children’s Hospital Boston, 2012 All rights reserved. Publication Date 12/15/11
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You must have a prescription to take
opioids.
For most opioids, only 30 days of opioids
can be prescribed at one time.
These medicines cannot be called in to a
pharmacy. A written prescription must be
brought in to the pharmacy.
You only have 30 days to fill a prescription
for opioids.
All care must be arranged with your
primary care doctors.
What are the rights and
responsibilities of doctors who
prescribe opioids for pain?
Doctors also have to follow laws when they
prescribe opioids for pain.
Doctors have to provide you with the best
pain care based on their expert judgement.
Doctors do not have to prescribe opioids if
they believe opioids are not right for you.
Doctors have to watch over (monitor) you if
you are using opioids to see if the medicines
are working and make sure you are not being
harmed. You have to follow the plan for
monitoring. If you cannot follow the plan,
then the doctor may stop working with you
and stop prescribing opioids.
Should opioid pain medicines be
used for long-term pain?
Experts do not agree on whether opioids
should be used for long-term pain because of
possible risks, including addiction. There may
be times that opioid pain medicines are right
for the treatment of long-term pain. It is very
important to monitor patients on long-term
opioid pain medicines. Close monitoring lets
us manage problems better.

Family Education Sheet • Frequently asked questions about Opioid
treatment for long-term pain
How do we monitor patients who
take opioids?
Some side effects, such as nausea and
itching, can be checked by asking if you are
having these problems. Other side effects
need to be monitored by asking your parents
or someone else to help. We check for side
effects such as changes in behavior, mood,
attention, reaction time, school work, and
your ability to care for yourself. Doctors will
work with you to come up with the best plan
for monitoring these side effects. If you aren’t
able to follow the plan, taking long-term
opioids may not be the right choice for you.
What are the side effects of taking
opioids?
Some side effects only happen for a short
time and go away with long-term use:
nausea (upset belly) or throwing up
sweating
dizziness (whirling feeling)
sleepiness
slow breathing
itchiness
headache
forgetfulness
trouble concentrating
slow reaction times
constipation (cannot poop)
hormone changes
moodiness
lower sexual desire
Some side effects may continue to happen no
matter how long you take opioids (such as
constipation, hormone changes, changes in
behavior, and physical dependence).
Hormone changes
Opioids may lower the levels of some
hormones. This can change some ways that
the body works, including how you feel about
sex.
Women: Tell your doctor if you are taking
opioid pain medicines, especially if you are
pregnant or plan on getting pregnant. If you
© Children’s Hospital Boston, 2012 All rights reserved. Publication Date 12/15/11
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have a baby while taking these medicines,
your baby will be physically dependent on
opioids. Taking opioids is not linked to a risk
of birth defects.
Men: Long-term opioid use may lead to low
levels of testosterone, the male sex hormone.
This could affect your mood, stamina (ability
to keep up), desire for sex, and physical and
sexual performances.
Working & Driving
Opioid pain medicines can cause some side
effects (such as sleepiness) that can affect
working and driving. These side effects are
common when you first start the medicine or
when you increase the dose. You should talk
to your doctor about your job and if it is safe
for you to work while taking opioids.
If you are taking opioids and want to get a
driver’s license, you will need extra tests (i.e.
to test your reaction time) before you can
start the driver’s license application.
Alcohol
You should not drink any alcohol (beer, wine
or hard liquor) while taking opioids. When
mixed with alcohol, the effect of these
medicines can be stronger. Sometimes this
can lead to a lower level of awareness and
slow or even stopped breathing.
Do opioids used as pain medicines
cause addiction?
Addiction is a problem where a person
cannot stop using a drug even though the
drug is harmful. An example would be a
patient who is using opioids for mood effects,
rather than for pain relief.
It is not common for people to become
addicted when taking opioids for short-term
pain from burns, wounds, and operations.
However, people who have a history of
addiction or mood disorders may be at risk
for addiction to opioids.
The risks of long-term opioid use are not well
known. Long-term opioid use for pain relief
has not been studied except in patients with
cancer. Many patients with cancer have safely
used opioids for long-term pain relief.

Family Education Sheet • Frequently asked questions about Opioid
treatment for long-term pain
What will happen if I suddenly stop
taking my opioid pain medicines?
Physical dependence happens if you take
certain drugs, including opioids, for a long
time (more than 2 weeks). If you suddently
stop taking these drugs you will have
withdrawal symptoms. Symptoms include
shaking, anxiety, grouchiness, trouble
sleeping, stomach cramps, diarrhea, pain,
hallucinations and sometimes seizures.
Withdrawal from opioids can be very
unpleasant, but it is not usually dangerous.
In most situations, we do not suggest
stopping opioids suddenly. If you wish to stop
taking opioids, you should slowly lower the
amount you take over time.
© Children’s Hospital Boston, 2012 All rights reserved. Publication Date 12/15/11
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Will opioids eventually stop working
as pain medicines for me?
Many patients taking opioids for a long time
will develop tolerance. This means the pain
medicine becomes less helpful over time. In
some cases, if the dose is raised the medicine
will work well again for a long time. In other
cases, the dose can never be high enough to
give good pain relief. Not all patients will
become tolerant and their dose will work well
for them as long as it is needed.
A Spanish version of this education sheet is
available from your provider.