Author: Mona Bapat, Ph.D., HSPP

Whether you are considering taking opioids to manage chronic long-term pain, for pain after an upcoming surgery, or to achieve opioid effects (the “high” they produce), it is important to know the types of opioids, their addictive potential, addiction warning signs, opioids side effects, and what to discuss with your doctor to determine the best pain-management plan for you.

Opiates vs. Opioids

Opioids fall into the class of medications called analgesics, meaning that they work to relieve pain.

The terms opiates and opioids are often used interchangeably however, they are different. “Opioid” is the umbrella term referring to all:

• Natural opioids
• Semisynthetic opioids, which are those manmade from a natural substance, and
• Synthetic opioids, those completely manmade through a chemical process.

Opiates are natural opioids; they are purely the chemicals found naturally in the poppy seed. Examples of opiates include:

• Heroin
• Morphine
• Codeine

Semisynthetic opioids include:

• Hydromorphone
• Hydrocodone
• Oxycodone (brand name OxyContin)

Fentanyl is a very powerful synthetic opioid. It is about 80 times more potent than morphine and has led to a steep rise in opioid overdoses. Other synthetic opioids include:

• Methadone
• Tramadol
• Buprenorphine

Common opioids that doctors prescribe for pain include:

• Codeine
• Fentanyl
• Hydrocodone (Vicodin)
• Oxycodone (OxyContin, Percocet)
• Oxymorphone (Opana)
• Morphine (Kadian, Avinza)

Short-Term Opioid Side Effects

The most common side effects of opioids include:¹

• Constipation
• Mental fogginess
• Nausea

Other side effects of prescription opioids, even when taken as directed, can include:

• Increased sensitivity to pain
• Sleepiness and dizziness
• Confusion
• Itching and sweating
• Low levels of testosterone reducing libido, energy, and strength
• Depression

Be sure and talk with your doctor if you experience depression as it may need to be further evaluated and treated.

Effects on the Immune System

In addition to their addictive potential, some opioids may also suppress your body’s immune response, in turn increasing vulnerability for infections. Morphine, fentanyl, and oxycodone are known to harm the immune system.⁷

Long-Term Side Effects of Opioids

Opioids are highly addictive because they trigger the release of endorphins. Endorphins are chemicals that decrease pain sensation and increase feelings of pleasure, also referred to as euphoria or “high.” The longer you use opioids, the higher the risk you have of developing an opioid use disorder (OUD), meaning that you continue to use opioids despite the negative impacts on your health and life overall.

Tolerance and Withdrawal

Tolerance and withdrawal with opioids develop very quickly. Tolerance means that your body has gotten used to the substance, and so over time, it needs more and more to produce the desired effect. This occurs because your body starts to slow its natural production of endorphins given the presence of the opioid.

Withdrawal means that because your body has been using that substance for a significant amount of time, if it is suddenly stopped or you quit “cold turkey,” your body struggles to function without the opioid. This can be a very uncomfortable or painful experience. Opioid withdrawal symptoms can include:

• Muscle pain
• Diarrhea, vomiting, or nausea
• Restlessness or sweating
• Anxiety
• Dilated pupils or watery eyes
• Cramping abdominal pain
• Fast heart rate
• Goosebumps
• Insomnia
• Tremor

Additionally, if you are pregnant or trying to become pregnant, it is important to know that the fetus is also exposed to the opioid in utero, which can lead the infant to go through withdrawal after birth.²

Opioid Addiction and Overdose

Because of their addictive potential, doctors usually prescribe opioids for about 3 days to manage acute (short-term) pain, such as post-surgery or post-injury pain.

Even for acute pain, there are opioid medications that have lower addictive potential that you can discuss with your doctor. These medications include:

• Morphine sulfate, immediate-release (MSIR)
• Tramadol
• Tapentadol

Though these medications are also opioid analgesics, they cause a lower degree of euphoria because they are less potent or don’t affect the reward centers in the brain as strongly. This reduces their addictive potential.

Your doctor may also put you on a tapering schedule toward the end of your medication regimen. This means that the doctor will slowly lower your dose over time rather than having you stop taking it abruptly. In other words, it is a way of weening you off the opioid to avoid experiencing withdrawal.

To get help for opioid addiction, call 800-934-1582(Who Answers?)

Who Is At Risk for Addiction?

The high addiction potential of opioids also makes them a “gateway drug,” meaning that if you misuse them, you are more likely to transition to misusing other substances as well.

For instance, one study found that younger people began their path of substance use with prescription opioids, usually Percocet. After becoming physically and emotionally dependent on opioid pills, the people in this particular study, to their surprise, started using heroin by first sniffing or smoking, followed by injecting.³

Another study found that prescription opioid use was more highly associated with heroin use compared to alcohol, marijuana, and cocaine.⁴ However, it is also possible that someone will use stimulants (substances that increase alertness and energy) such as cocaine to compensate for the sedating effects of opioids.⁵

Some factors that put you at higher risk of misusing opioids include:

• History of substance abuse
• Family history of substance abuse
• Young age
• History of mental health disorders such as clinical depression or anxiety
• Heavy tobacco use

Opioid Overdose

Signs of overdose on an opioid can include:

• Slow, shallow breathing
• Choking or gurgling sounds
• Limp body
• Pale, blue, or cold skin
• Small, constricted pupils
• Sleep or loss of consciousness

If you notice any of these signs in yourself or a loved one, get medical attention right away.

Questions to Ask Your Doctor

Having a comprehensive discussion with your doctor can help to set the best pain management goals for you. Some questions to ask your doctor are:¹

• How long will I be taking the opioid for pain management?
• Can you help me understand what my baseline pain level is?
• How should I rate my pain day-to-day so that I can judge improvements?
• What side effects can I expect?
• Are there potential drug interactions with the medications I’m currently taking? What should I not take or ingest while taking opioids?
• What do I do if I accidentally overdose on the opioid?
• What tapering plan can we establish to avoid withdrawal symptoms?
• What can we do to reduce my risks of developing an OUD?
• How do I safely store the medication and dispose of unused opioid medication?
• I am pregnant or plan to become pregnant, so what pain medication would you recommend?
• Are there options for me besides opioids?

No matter your physical or mental health history, you are not completely immune to the dangers of opioids. Being mindful of this and having a carefully laid-out treatment plan with your doctor can help to minimize risks. Your doctor can help you weigh the benefits versus the risks of opioid medications for your unique situation.

Treatment is effective for those struggling with an OUD. If you are dealing with illicit opioid use or an OUD, the sooner that you seek treatment, the better the prognosis for recovery.

One study found that a vast majority of participants were able to experience positive outcomes with medication treatment. Three years after beginning treatment, more than 31% of participants who had medication treatment were abstinent from opioids and no longer on the treatment, 29% were still on medication treatment but met no criteria for current opioid dependence, and about 31% were using opioids again without treatment.¹⁰

If you’re worried about your level of opioid use or that of a loved one, get help today at 800-934-1582(Who Answers?) .

References

1. Gupta, A. (2019). Are you taking opioids for pain? 5 topics to discuss with your doctor.
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3. Mars, S.G., Bourgois, P., Karandinos, G., Montero, F., & Ciccarone, D. (2014). “Every ‘never’ I ever said came true”: Transitions from opioid pills to heroin injecting. International Journal of Drug Policy, 25(2), 257-266.
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5. Compton, W.M., Valentino, R.J., & DuPont, R.L. (2021). Polysubstance use in the U.S. opioid crisis. Molecular Psychiatry, 26, 41-50.
6. Gomes, T., Juurlink, D.N., Antoniou, T., Mamdani, M.M., Paterson, J.M., van den Brink, W. (2017). Gabapentin, opioids, and the risk of opioid-related death: A population-based nested case-control study. PLoS Medicine, 14(10).
7. Plein, L.M., & Rittner, H.L. (2018). Opioids and the immune system-friend or foe. British Journal of Pharmacology, 175, 2717-2725.
8. Ray, W.A., Chung, C.P., Murray, K.T., Hall, K., & Stein, C.M. (2016). Prescription of long-acting opioids and mortality in patients with chronic noncancer pain. Journal of the American Medical Association, 315(22), 2416-2423.
9. Deyo, R.A., Von Korff, M., & Duhrkoop, D. (2015). Opioids for low back pain. BMJ, 350.
10. Weiss, R.D., Potter, J.S., Griffin, M.L., Provost, S.E., Fitzmaurice, G.M., McDermott, K.A., Srisarajivakul, E.N., Dodd, D.R., Dreifuss, J.A., McHugh, R.K., & Carroll, K.M. (2015). Long-term outcomes from the National Drug Abuse Treatment Clinical Trials Network Prescription Opioid Addiction Treatment Study. Drug and Alcohol Dependence; 150, 112-119.