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Q & A: All about opioids, their benefits and risks

The escalating problem of prescription drug abuse has cast a spotlight on opioids, the narcotic painkillers that doctors are prescribing in record numbers, yet are being abused and killing more people than ever. In 2006, the most recent year for which federal statistics are available, 180 million prescriptions were written for these drugs. And 11,000 people died from misusing them. Experts say the numbers have continued to skyrocket since then.

Though laws have been passed in Florida over the past year to curb abuse of prescription drugs, including opioids like oxycodone and hydrocodone, some wonder why doctors prescribe such potentially dangerous drugs in the first place. The answer is simple: When taken as directed, doctors say, opioids can quickly, effectively, inexpensively — and safely — curb severe pain. The trouble comes when patients don't follow orders or when doctors don't carefully monitor patients.

What are opioids?

Opioids are narcotic pain medications that are chemically similar to opium, a substance collected from the poppy plant, which is the source of heroin. Besides oxycodone and hydrocodone, other legal opioids include morphine, fentanyl, methadone and codeine.

How do they work?

Pain messages are sent from the point of injury through your nerves, to your spine and then to your brain. Opioid drugs essentially block the pain messages to your brain, changing the way pain is experienced. Opioids can also affect other regions of the brain, causing the user to experience euphoria.

Opioids work differently from medications such as ibuprofen or aspirin. Dr. Charles Brock, an associate professor of neurology at the University of South Florida, explained that, for instance, ibuprofen reduces the inflammation associated with painful conditions like arthritis. "It reduces the actual reason for the pain," he said. "An opioid blocks the perception of the pain, but it's not doing anything to reduce the reason for the pain."

What are the side effects and dangers?

Just as they change perception of pain, they also can affect perception of reality, leading to confusion or delirium, Brock said. Minor side effects include drowsiness and constipation. Most serious: A large single dose can kill you by stopping your breathing, according to the National Institutes of Health.

Alcohol, antihistamines, barbiturates and benzodiazepines all aggravate these dangers and should not be used with opioids.

Extended use can lead to dependence, addiction and increased tolerance. Over time, more drug is needed to achieve the same affect, the NIH says.

How can doctors ensure patients' safety?

Brock said the opioids should be considered just one option for pain, along with other medications and nondrug treatments like physical therapy. Patients need to be counseled on the potential risks of opioids and need to be closely monitored.

NIH adds that patients should be medically supervised when stopping opioids to reduce symptoms of withdrawal.

So, why aren't other treatments like surgery, physical therapy or acupuncture the first course of action?

Dr. Alfred Chapman, a pain management physician in Clearwater, said that in a bad economy — and with millions of Americans lacking health insurance — many people turn to opioids for fast, cheap relief. Consumer Reports estimates the average monthly cost of generic codeine with acetaminophen, in 120-milligram daily doses, at $31. Generic oxycodone, in 20-milligram daily doses, is $86 to $100.

Richard Martin can be reached at rmartin@sptimes.com or (727) 893-8330.

Q & A: All about opioids, their benefits and risks 06/04/10 [Last modified: Saturday, June 5, 2010 9:36pm]
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