What Are They?
Prescription opioids are medications used to treat various types of pain, cough, diarrhea, and in the operating room, for sedation/anesthesia.1,2
Opioid medications are available as capsules, tablets, injectable solutions, syrups, lozenges, and patches that can be applied directly to the skin. Users may abuse these drugs by swallowing, smoking, snorting, or injecting them.2
Different opioid painkillers come from various sources. Naturally occurring opioids include codeine and morphine and are derived from substances found in the opium poppy plant, while synthetic opioids, like fentanyl and methadone, are manufactured in a lab. Semi-synthetic opioids are the result of chemical modification to naturally occurring opiate precursors and include prescription painkillers like oxycodone and hydrocodone.2
The Drug Enforcement Administration (DEA) classifies opioids and other drugs based on a ranking from Schedule I to Schedule V. To determine scheduling as a controlled substance, the DEA takes into account the drug’s potential for abuse and dependence, safety, and whether the drug is currently used for medical purposes.2
- Many prescription painkillers, including morphine, hydrocodone, oxycodone, and fentanyl, are Schedule II drugs because they carry a high potential for abuse and dependence, but can safely be used for medical purposes under proper supervision.2
- Schedule III opioids, such as codeine and morphine combination products, have less potential for abuse than Schedule I or Schedule II drugs, accepted medical treatments, and moderate or low dependence potential.2
- Schedule IV opioids, such as tramadol, have a low potential for abuse, accepted medical use, and limited physical dependence.2
- Schedule V opioids, such as cough medicines containing codeine, have the lowest abuse potential, are associated with limited physical and psychological dependence, and have accepted medical use.2
Types of Painkillers
- Hydrocodone, in its various formulations, is used to treat moderate to severe pain. The drug is most commonly prescribed as tablets and capsules to be taken orally. However, some users misuse the drug by taking larger doses or crushing it up to snort, smoke, or inject.2,3
- Oxycodone is the active ingredient in branded painkillers like OxyContin and Percocet. Various oxycodone formulations are available as extended- and immediate-release tablets and capsules. Like hydrocodone, oxycodone users are known to abuse the drug by snorting, smoking, or injecting it.2
- Fentanyl is a strong opioid medication that is more potent than both heroin and morphine. The drug may be administered as sublingual tablets, lozenges, metered nasal sprays, transdermal patches, dissolvable films, and injectable solutions. Fentanyl can be misused in a variety of ways, including snorting, smoking, injecting, or consuming it orally. Some users also abuse the drug by removing the gel from the patches and injecting it or placing it under the tongue or in the cheek.2
- Morphine is available as an injectable solution, an oral solution, and as both extended- and immediate-release tablets and capsules. While the drug can be consumed orally, many people who abuse morphine prefer to inject it to enhance its pleasurable effects.2
- Carfentanil is a fentanyl analog drug that is used to tranquilize large mammals. It is more potent than heroin, fentanyl, and morphine and has been linked to many overdoses. Illicit carfentanil has been encountered as powder, tablets, blotter paper, and spray. The drug is not considered safe for humans and even small doses absorbed through the skin can have deadly consequences.4
How They Work
Opioid painkillers reduce the transmission of pain signals by activating opioid receptors in the brain, spinal cord, and other organs throughout the body.1,5
The activation of opioid receptors from prescription painkiller use can also influence reward pathways in the brain, leading to pleasurable effects like euphoria, especially when large doses are used.1
Short-Term Effects and Side Effects
In addition to pain relief and euphoria, other short-term effects of opioid painkillers include:2
- Slowed bodily movements.
- Constricted pupils.
- Reddening of the face and neck.
- Nausea and vomiting.
- Slowed breathing.
The short-term effects can last for different amounts of time based on the drug. Some prescription painkillers, including oxycodone, hydrocodone, and morphine, are available in extended-release forms.2,3,6,7 Unlike immediate-release medications, extended-release painkillers slowly release the medication over a period of time, rather than all at once. The effects from extended-release medications often last between 12 and 24 hours, while the effects from immediate-release medications may last 4 to 6 hours.3,6,7
Some users may also experience other reactions or side effects from using these drugs, such as:3,6,7
- Changes in mood.
- Dry mouth.
- Back pain.
- Muscle tightening.
- Stomach pain and cramping.
- Painful urination.
- Ringing in the ears.
- Sleeping problems.
- Swelling of the body.
Long-term health effects of using painkillers can include:8
- Chronic constipation.
- Sleep apnea and other sleep-related breathing issues.
- Decreased testosterone in men.
- Osteoporosis and irregular menstrual periods in women.
- Increased sensitivity to pain.
- Increased risk of fractures, falls, and accidents.
- Increased pneumonia risk.
- Cardiovascular disease.
- Increased risk of overdose.
Long-term painkiller abuse can also significantly increase the risk for developing tolerance, physical dependence, and addiction.1,8 Tolerance means the user needs to take higher doses of the drugs to feel the same effects as before.1 Tolerance is often accompanied by physical dependence, in which the person’s body adapts to regular exposure to the drug.
One aspect of dependence is withdrawal, which is a set of symptoms that occur when a person cuts back or stops altogether.1,5 People who use painkillers over an extended period of time may develop significant enough levels of physiological dependence that they are likely to experience very unpleasant withdrawal symptoms, which can make it challenging to quit without help.1
Symptoms of opioid withdrawal can include:1,2
- Runny nose.
- Watery eyes.
- Cold sweats.
- Goose bumps.
- Increased heart rate and blood pressure.
- Muscle and bone pain.
- Involuntary leg movements.
Withdrawal from opioid painkillers may be managed by tapering a person off of the drug.1 This involves gradually reducing the dose over a specified period of time. Tapering should always be done by a medical professional since opioid painkillers carry health and overdose risks.
In addition to physical dependence, some painkiller users may develop an addiction.1,5 People who are addicted will often continue to use a drug in spite of negative consequences, such as job loss, legal issues, and family problems.
- The rate of painkiller use, including people who use painkillers for both medical and nonmedical purposes, is estimated to be around 38% in the United States, which is higher than the country’s rate of tobacco use.9
- Approximately 259 million prescriptions were written for opioid painkillers in 2012.10
- Over 100 million Americans suffer from chronic pain. Exact rates of opioid addiction among chronic pain patients is unknown but may be as high as 26%.1
- Nearly 2 million Americans ages 12 and older were addicted to prescription painkillers in 2015.10
- In that same year, 276,000 adolescents reported currently using prescription painkillers for nonmedical purposes and 122,000 adolescents were addicted to painkillers.10
Prescription painkillers can cause short- and long-term health effects and can lead to dependence and addiction. If you or someone you know has a problem with prescription painkillers, reach out today for assistance finding a treatment center.
- National Institute on Drug Abuse. (2018). Misuse of prescription drugs.
- Drug Enforcement Administration. (2017). Drugs of abuse: A DEA resource guide.
- U.S. National Library of Medicine. (2018). MedlinePlus, Hydrocodone.
- Drug Enforcement Administration. (2016). DEA issues Carfentanil warning to police and public.
- National Institute on Drug Abuse. (2018). Types of prescription drugs.
- U.S. National Library of Medicine. (2018). MedlinePlus, Oxycodone.
- U.S. National Library of Medicine. (2018). MedlinePlus, Morphine.
- Baldini, A., Von Korff, M., & Lin, E. H. (2012). A review of potential adverse effects of long-term opioid therapy: a practitioner’s guide. The Primary Care Companion to CNS Disorders, 14(3).
- Ingraham, C. (2016). Prescription painkillers are more widely used than tobacco, new federal study finds. The Washington Post.
- American Society of Addiction Medicine. (n.d.). Opioid addiction 2016 facts and figures.
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