Though painkillers are prescribed by physicians, opioid side effects can be serious and life-threatening. Prescription opioid use has quadrupled since 1999, prompting a heavy increase of abuse and addiction-related fatalities.
Studies + Science
The Next Steps
|Opioids, like Oxycodone and Oxycontin, are highly addictive prescription drugs.||Though safe opioid use comes with a number of side effects, misuse may be fatal.||The FDA has expressed concern about an increase in opioid-related overdoses.||Assistance for individuals dealing with opioid side effects are available.|
Originating in southwest Asia, opioids are powerful chemical substances derived from the opium poppy plant. Opioids are available in many forms, and often prescribed by physicians after accidents, injuries or surgeries to mitigate and manage pain.
As a member of the analgesic drug class, opioids relieve pain and produce euphoric effects. Opioids may also be used in combination with other medications to suppress a cough.
According to the Centers for Disease Control and Prevention (CDC), prescription opioids are responsible for more overdose-related deaths than any other drug. Opioids are misused when individuals consume an unprescribed dose to feel euphoric effects.
When taken for non-medical use, prescription painkillers can become severely addicting. Opioid side effects are debilitating and dangerous. Overdose-related deaths are increasing, and the CDC reports more than three out of five deaths involve an opioid.
CDC Common Terms
- Opioid use disorder –
- A problematic pattern of opioid use that causes clinically significant impairment or distress. A diagnosis is based on specific criteria, such as unsuccessful efforts to cut down or control use, as well as social problems and a failure to fulfill obligations at work, school, or home. Opioid use disorder has also been referred to as “opioid abuse or dependence” or “opioid addiction.”
- Physical dependence –
- Adapting to a drug that produces symptoms of withdrawal when the drug is stopped.
- Tolerance –
- Reduced response to a drug with repeated use.
- Drug misuse –
- The use of prescription drugs without a prescription, or in a manner other than as directed by the prescriber.
- Overdose –
- Injury to the body that occurs when excessive amounts of a drug are consumed. An overdose can be fatal or nonfatal.
- Medication-assisted treatment (MAT) –
- Treatment for opioid use disorder combining the use of medications (methadone, buprenorphine, or naltrexone) with counseling and behavioral therapies.
Studies + Science
Opioids come in various forms and doses, including capsules, tablets, patches, liquids, and powders. Opioids can be taken intravenously, topically or orally.
Prescription opioids may be formulated in combination with different active ingredients and in extended-release variations. There are three categories of opioids, though heroin is often placed within a separate classification.
How Opioids Work
When consumed, opioids move through the bloodstream to the brain. Opioids then bind to brain receptors to send pain-relieving signals to the body. The analgesic effects decrease the feelings of pain while increasing tolerance to pain. Opioids also work with the spinal cord to reduce pain.
Opioid use creates changes in the brain to trigger a biochemical reward system. Feelings of euphoria and pleasure make users dependent on the drug, which leads to misuse, dependence, and addiction. Some individuals may have a genetic predisposition to addiction, with abnormal brain pathways making the individual more likely to develop a dependence.
Common Opioid Side Effects
- Respiratory depression
- Shallow breathing
- Slurred speech
Less Common Opioid Side Effects
- Delayed gastric emptying
- Immune and hormone dysfunction
- Muscle rigidity
Abuse, Dependence + Addiction
According to the National Institute on Drug Abuse, the number of people abusing opioids is estimated at 2.1 million in America and between 26.4 and 36 million globally. Abuse can lead to tolerance, dependence, addiction, and overdose.
Chronic use of opioids creates abnormal brain structures that lead to compulsions and cravings. When opioid medications are used for an extended period, the body grows accustomed to the effect. Over time, the body builds a tolerance and requires more of the drug to achieve euphoric feelings. Tolerance can increase the risk of accidental overdose.
Opioid addiction, built on a growing dependence the effect, is when psychological cravings are paired with symptoms of physical withdrawal. The body experiences symptoms of withdrawal when opioid use is discontinued.
During withdrawal, opioid side effects may worsen after the first few days. The detoxing process may sometimes be mistaken for the flu because withdrawal puts stress on the body, and if left unmonitored, it could become life-threatening. Symptoms of opioid withdrawal include, but are not limited to:
- Euphoria or general discontent
- Chronic constipation
- Abdominal pain
- Small or dilated pupils
- Nausea and vomiting
- Reduced sex drive
- Sensitivity to pain
- Muscle aches
- High blood pressure
- Blurry vision
- Teary eyes
- Runny nose
- Inability to sleep
- Rapid heartbeat
Treatment + Recovery
Because addiction creates serious physical and psychological side effects, people often need professional treatment to recover. Recovery is a long process that requires cognitive and biological healing. The first step in treating an individual with opioid use disorder is detoxification, which may take weeks or days after last use.
Individuals addicted to opioids must receive treatment to overcome abnormal brain structures that create cravings and lead to withdrawal symptoms. Certain medications, like Clonidine, Naloxone or Suboxone, are used to help with withdrawal.
Recovery requires medication monitoring, in-patient treatment, group therapy, and support from family and friends. It is common for those in recovery to relapse during the rehabilitation period. Programs like Narcotics Anonymous have been successful in helping some patients transition. People may choose to reside in sober living after in-patient treatment is complete.
Regardless of successful program completion or a stay in sober living, recovered individuals may start using when faced with stressful psychological or environmental challenges.
Opium, heroin, and prescription painkillers have a long and complex history. The Food and Drug Administration (FDA) has been working to better regulate opioid medications for decades.
As the epidemic grows, safe use of prescription opioids becomes more difficult.
History of Opioids
Healers have used opium-derived substances for centuries. Since the passing of the Heroin Act in 1924, the importation, manufacture, and possession of heroin have been illegal–even for medicinal use.
However, medical variations, such as codeine, morphine and oxycodone, were still available. The FDA approved Percodan, an oxycodone-aspirin combination, in 1950. The use of oxycodone started to grow, expanding in the 1960s.
|Schedule I |
No accepted medical use
|Schedule II |
High potential for abuse and dependence
|Schedule III |
Moderate potential for abuse and dependence
|Schedule IV |
Low potential for abuse
Less than 15 mg of Hydrocodone
|Less than 90 milligrams of codeine|
Cough preparations with less than 200 milligrams of codeine or per 100 milliliters
Later, in the 1970s, the Controlled Substances Act was passed. The act regulated opioid drugs into schedule categories based on medicinal benefit, harmfulness, and potential for abuse or addiction. Heroin remains a schedule I drug, whereas other drugs are Schedule II and III.
In 1978, German pharmaceutical company Knoll released Vicodin, a combination of hydrocodone and acetaminophen. While President Nixon called for the War on Drugs, people suffering from cancer and other chronically painful illnesses lobbied to increase access to these medications. Despite a number of serious opioid side effects, patients with chronic pain demanded the medications for their care.
In the 1990s and 2000s, the FDA expanded the uses of opioid-derived drugs. The market subsequently grew, and so did the abuse. From 1998 to 2008, the misuse of OxyContin, Vicodin, Percocet, and Lortab doubled.
Today, the FDA works to regulate opioids, releasing a number of safety alerts, labeling changes and prescribing guidelines. The agency is in the process carrying out the following actions:
Expand use of advisory committees
Develop warnings and safety information for immediate-release (IR) opioid labeling
Strengthen postmarket requirements
Update Risk Evaluation and Mitigation Strategy (REMS) Program
Expand access to abuse-deterrent formulations (ADFs) to discourage abuse
Support better treatment
Reassess the risk-benefit approval framework for opioid use
The Next Steps
According to the CDC, 33,091 deaths involved an opioid in 2015. The opioid problem in the United States has continued to worsen, with opioids gaining increased attention from health care, politics, and news organizations.
If you’re struggling with side effects from prescription opioids, you have access to helpful resources. Advocates are standing by.