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Old 09-10-2008, 03:29 PM   #1
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Question Are opioids safe?

One of you said that opioids were safe. Could you please elaborate on that and maybe tell me where to find some documentation? Some of my dear relatives are so worried about me being on them and my MIL especially thinks they will ruin my liver. I'd love to be able to reassure her. Thanks guys,

wren

Last edited by HBMod07; 09-14-2008 at 01:31 PM.

 
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Old 09-10-2008, 04:35 PM   #2
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Re: Are opioids safe?

Wren,

Opioids are some of the safest medications available. The full agonists, meaning those with no tylenol or aspirin or anything else added, cause no organ damage at all.

Tylenol, on the other hand, can cause liver damage if taken in excess. The maximum one can take in a day is 4,000mg. If taken chronically, many docs like to see that number dropped to 3,000mg daily as a max. So long as you follow the rules then even these are safe.

Some people are allergic to certain drugs. Some suffer serious side effects. Opioids have their own side effects. The effects most desired are analgesia (pain relief) and anxiolysis (anti-anxiety/sedation). If a patient is ambulatory, then the sedation can be a problem, but most folks adjust to it after a bit. The undesirable side effects of opioids range from constipation, to nausea, some vomiting, dizzyness, etc. Being a central nervous system depressant these side effects are expected in some. However, most folks develop tolerance to these effects with chronic use. The one side effect that we do not develop tolerance to is constipation. And anyone treated with opioids chronically should also be treated with stool softeners and some kind of non-stimulant laxative. This should be part of opioid therapy.

Most people equate opioids with addiction. This is so unfortunate. There is debate in the medical community about the percentage of folks treated with opioids chronically that are expected to develop addiction, and most believe it is between 1% and 10%. Most believe it is closer to 1% than 10%.

Most also do not understand the difference between dependence and addiction. All people who take opioids chronically will develop dependence. The body will become accustomed to the opioid, and when stopped abruptly they will experience what's known as "abstinence syndrome." In other words, withdrawals (WD). This is normal. Opioids are not the only class of medications that cause dependence, and you can look that up to see which other do the same thing.

Addiction is a psychological condition whereby one is consumed with acquiring and taking opioids even when they are causing harm. This is almost a textbook definition of addiction. An addict spends their waking hours seeking opioids, taking them, enjoying the high, or whatever is left of it, and then acquiring more. Most regularly experience WDs, they call it being "sick," because they don't have the funds or means to have opioids on hand 24/7. Unless caught early, this usually results in folks begging, borrowing and stealing opioids or whatever can be used to get them. Nothing is more important than their opioid. That's addiction.

One more condition is pseudo-addiction. This happens when a person in pain is undertreated and behaves in many ways like an addict in order to locate opioids to ease their suffering. The difference between addiction and pseudo-addiction is that once a proper dose is given to the pain patient the "addictive behavior" stops.

One important consideration - It is critical that anyone who is thinking of taking opioids around the clock takes into consideration the issue of dependence. Even though it is a natural outcome, it nevertheless does happen and is a life-changing condition. Once one is dependent on opioids it can be very, very hard to go back. There are ways to do this, like a slow titration to lower and lower doses until one is off of the drug. This is preferable. Detox is another way. This is more difficult but it does work. And it can take quite some time to return to feeling normal. When dependent on opioids, the body responds by stopping production of endorphins, the natural "morphine" produced by the body. Once off of opioids one can feel terribly depressed. Sleep is hard to come by. And the adjustment can take some time. It depends on how long one has been dependent and how high a dose one was on. It is not easy. So, no one should get into chronic opioid therapy lightly.

Opioids consist of meds like codeine (Tylenol 3), morphine (MSIR, MS Contin, Kadian, Avinza), hydrocodone (Vicodin, LorTab, Norco), oxycodone (OxyFast, OxyIR, OxyContin), hydromorphone (Dilaudid), oxymorphone (Opana), fentanyl (Duragesic, Actiq, Fentora), methadone (Dolophine), etc. These are the full agonists I wrote about earlier. Some opioids are mixed with other meds like acetaminophen (Percocet is oxycodone and acetaminophen, Vicodin is hydrocodone and acetaminophen), aspirin (Percodan is oxycodone and acetaminophen), or Motrin (Motrin and hydrocodone is Combunox). There are other opioids that are slightly different, and are called partial agonists and such. Meds in this category include Suboxone (buprenorphine), Talwin (pentazocine), etc. These are less often used because they have a ceiling, or a dose that cannot be exceeded because the side effects get too bad.

Bottom Line - Opioids are extremely safe to use. Like other meds, they have their own side effects and risks. If proper patient selection is followed (e.g. strongly evaluate giving meds to those with drug or alcohol abuse in their past, or blood relatives who were addicted), and proper dosing is done, with frequent follow-up and overall good Pain Management, there's no reason to fear opioids or to be afraid for family members that are prescribed opioids. The same cautions should be followed for all who are prescribed anti-depressants, blood thinners, insulin, and a slew of other medications.

Society needs to get over it's phobia of opioids. Doctors need to get over their fear of opioids. They are safer than many of the other meds being prescribed on a daily basis. Unfortunately the press and the medical community have turned compassionate doctors and patients with chronic pain into criminals and societal outcasts. Chronic Pain patients are treated with distain and disrespect in doctor's offices and pharmacies. It's hard enough accepting a life of chronic pain, but then to be treated poorly by the medical community and one friends and neighbors - this is awful. The worst thing is when uneducated family members shun those among them who are in pain and on opioids, talking behind their backs, or confronting them head on with the evils of opioids. This is why so many of us have taken to telling no one about our meds. Many of us have even had to keep it from family. These lessons are hard to learn.

I hope this helps. There are so many places online to learn more about opioids and how safe they are with respect to other drugs we take daily and think nothing of.

Happy Hunting...

steve

 
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Old 09-10-2008, 07:27 PM   #3
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Re: Are opioids safe?

I have to 2nd Conductor's comment. :-) I do have to add a few cons to the list. I agree that opioids used according to the doctor's instructions are some of the safest meds - really no major effects on the major organs for the most part.

A couple additional cons. There some mixed evidence about how opioids can suppress the immune system. However, severe chronic pain suppresses the immune system far more than opioid medications. Long term use of opiates also frequently affects the hormones and both men and women may need additional meds to help with the hormonal problems caused by the meds. Some people [both men and women] supplement their testosterone. Supplemental T is controversial. Obviously, it's much better to have your body producing enough hormones on it's own.

The negative health effects of severe chronic pain [and I'm not talking about the basic ability to function but how pain acts on the body] far outweigh any negative health effects of opioid medication however.

Last edited by Confused089; 09-10-2008 at 07:29 PM.

 
Old 09-11-2008, 11:08 AM   #4
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Re: Are opioids safe?

Jon and Confused,

Thanks so much for the kind words. Much appreciated.

I agree with Confused on the hormone issue. I am one of those taking Hormone Replacement. We do not know how much of my low Testosterone was due to the opioids or the brain tumor, but I believe the opioids account for a significant percentage, as it is truly a side effect. But, bottom line, as Confused points out, chronic pain is much harder on the body than any of the opioid side effects.

steve

 
Old 09-11-2008, 03:56 PM   #5
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Re: Are opioids safe?

Thank you, steve, for taking the time to answer so thoroughly. REMOVE I do have a past history of abuse and psychological addiction (but nothing with opioids). My PM doctor is aware of this and feels I am doing okay. When I came off of "drugs" in 1982, I was so afraid of getting back into that scene again that I would not even take aspirin and I suffered with pain about 20 years. Then when I finally allowed myself to go on pain meds, the relief was so wonderful that I kept asking for increases and within 2 years I was on three or four 10 mg of Percoset a day and starting OxyContin to boot. I got scared with the way I was increasing and dropped everything cold. I "endured" for 6-12 months taking only a quarter of a Percoset here and there. Last October, the pain became unbearable again and I have been careful not to increase too quickly this time. After one year, I am taking 10/325 of hydrocodone 3 times a day and trying not to increase at all. Of course, my family's fears are rooted in the past.

As for side effects, I do have mild nausea almost everyday and the constipation is bad. I've tried a lot of OTCd things, but nothing really works. I tried one prescription, too, but had a bad side effect. The only thing that works for me is a plain water enema about every other day. I am open to suggestions.
Blessings,
wren

Last edited by Mod08; 09-11-2008 at 08:56 PM.

 
Old 09-13-2008, 09:56 PM   #6
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Re: Are opioids safe?

As far as the constipation is concerned I have only found one medication to do the trick without any nasty side effects that usually result from constipation meds. I take 1-2 doses of OTC Miralax. I just add it to my water along with one of those flavored packets that are popular nowadays. I started getting relief after just a few days.

I would suggest giving this a try if your doc says it is ok. My doctor and I tried a lot of other things first but Miralax has become a miracle for me.

Good luck...keep us posted!
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Old 09-23-2008, 12:02 AM   #7
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Re: Are opioids safe?

except in gross overdoseage, they are exceptionaly safe.... no organ toxicity or long term effects, other than dependence, and the rareish posability of addiction.

 
Old 10-28-2008, 07:47 AM   #8
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Re: Are opioids safe?

Hi,

This post is a few weeks old, but I wanted to reply on one point that I don't think has been really discussed.

The big difference between getting pain relief and becoming addicted, in my opinion, is how the medicine feels to someone. The typical person who takes Opioids, when you don't have chronic pain they are dealing with, is that they will feel euphoric. While someone with a lot of pain will only feel some or most of their pain relieved. Without the euphoric feeling, I don't believe that patients become addicted. If they stop the medicine, the pain comes back, and that is what they deal with the most.

While I appreciate all the information Forginon supplied, this is where I dissagree with him (or her). My cronic pain is bad enough that I can't function without the pain relief--it is not a choice! The main pain medicine I have been on has been mostly morphine medicines (Avinza), as well as on oxymorphone (Opana). And I think that most people that reach the point where they need the strong and long-term pain relief that the Opioid medicines provide, don't have much choice either. I have also had several occasions where I stopped taking the pain medicine. One time I was off the medicine for 11 days--I had a job opportunity that I was going to take a drug for, and I was worried about that. You body becomes very uncomfortable, but the main thing I then wanted was relief from the pain that came back.

The thing I would tell you Wrenegade, is to tell your family the differences I pointed out above. As you talk to them, and other relatives, you may find others that are on these medicines as well. Since people don't talk about it much, except with those they know can sympathize with them, you may be surprised to find other people that you know that are dealing with cronic pain as well. And then you also find people that have been on the pain medicines for 10 years, 15 years, or longer.

I hope this helps. Let us know how it is going Wrenegade!

 
Old 01-21-2009, 12:43 PM   #9
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Re: Are opioids safe?

This thread is a few years old, but I would like to add some of my thoughts to it.

On opioid medicine being safe, Steve wrote a nicely detailed response that I mostly agree with. Including that most people, especially most doctors, don't understand that for patients like me, with chronic pain, these drugs give me pain relief. They don't make me high! And as far as going off of them, if the pain went away, I know I would have no trouble stopping the pain medication.

When I was younger I spent many episodes (approximately 10 days at a time) in the hospital getting morphine and Demerol shots every few hours, which I did have to come off of after I went home--this was to counter pain from very strong chemotherapy treatments. So I know the difference between that and the opioid pain medicine generally being prescribed for people that need ongoing pain relief to live their lives and even possibly work--to earn some money to pay for these costly medicines.

It is easily understood that when a medicine gives you a high or euphoric state, then you might want that to continue. But again, my pain relief doesn't do that in any degree. The extended release drugs that doctors are prescribing are designed that way. They are designed to give a steady pain relief over time, rather than a short burst of relief.

The comments by Confused are very important. And I wish someone would have told me about that when I started on these opioid pain medications. One thing I would add to it though is that you should look at Bio Identical hormone therapy, rather than the synthetic hormone therapy that a lot of main stream doctors prescribe. From my research, one of the reasons that hormone therapy is so controversial (as mentioned by Confused), is that there are many problems with the use of the synthetic hormones. But there are several good studies showing that these problems are not found with the use of Bio Identical hormones. A good book related to this topic is Suzanne Somers' "Breakthrough".

I guess I would also add, that I know people that have been on opioid medicines more than ten years. As with myself, it has allowed them to live a life with less pain. Pain that they otherwise probably could not live with, for very long.

 
Old 03-24-2009, 06:45 PM   #10
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Re: Are opioids safe?

Quote:
Originally Posted by forginon View Post
Jon and Confused,

Thanks so much for the kind words. Much appreciated.

I agree with Confused on the hormone issue. I am one of those taking Hormone Replacement. We do not know how much of my low Testosterone was due to the opioids or the brain tumor, but I believe the opioids account for a significant percentage, as it is truly a side effect. But, bottom line, as Confused points out, chronic pain is much harder on the body than any of the opioid side effects.

steve
steve, i havent been on board for awhile so never did hear how you were doing. i last read last summer or fall when you had severe headache. i gather there was a cause. so what i am wondering, is that after all this, do you still have migraines? if so, what helps you. Dee

 
Old 03-31-2009, 01:26 AM   #11
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Re: Are opioids safe?

imo the only pain killers that are safe are norco or vicodin hydrocodne based pills. when it comes to pain killers there in the weaker class of them, and you rarely if ever hear about people accidentally overdosing on them. But once you get into the oxycondone family "Oxycontin", "Percocet" then youre running a high risk of a accidental od. This is from what i've heard over the years and just in general of watching the news.

 
Old 03-31-2009, 05:10 AM   #12
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Re: Are opioids safe?

Don't beleive everything you see on the news. In general the media has set out to intentionally demonize any type of prescription pain medication. They don't do stories on the CP paitient who got their life back with opiate therapy, rather they focus on the person who stole that CP paitients meds, took the whole bottle and died. The story about the CP paitient doesn't fit their agenda so they don't run it. Just because the manufacturer of tylenol has been producing commercials on how "safe" their product is doesn't mean it's true, truth in advertising laws can obviously be pushed further than they should be. Opiates are generally much safer than tylenol.

If a person follows the Dr.'s instructions to the letter they will have no problems with opiate medications, problems genrally occur when a person takes more than is prescribed. People with chronic pain who are on long term opiate therapy develop tolerance over time and require higher doses of opiates than someone who has just started taking an opiate medication after surgery or an injury. You can't compare what a person who has been treated for CP for 5 years takes to what a person who had surgery this week takes. Providing the surgical paitient is not also a CP paitient they will likely require less medication than the CP paitient.

Tylenol or vicodan which has tylenol in it, can be very dangerous if even a slight amount over the daily max is taken, the result of too much tylenol is irreversable damage to the liver. For some people, it would only take an additional tylenol tablet over the limit of 4000 mg to cause irreversable damage to the liver. Once that happens the ONLY treatment available is a liver transplant.

 
Old 03-31-2009, 12:41 PM   #13
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Re: Are opioids safe?

My PM Doc told me yesterday " Chronic Pain meds needed on a daily basis is NO DIFFERENT than someone who needs their blood pressure meds, their Lipitor or other such medications. I think the difference exists in that you can DIE without taking BP meds and Lipitor meds but I understand her reasoning

 
Old 03-31-2009, 02:40 PM   #14
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Re: Are opioids safe?

Go on the FDA site and look at the list of medications and their death rates. The last time I looked acetaminophen(Tylenol) was in the #3 or 4 position. This is the same ingredient in Vicodin & Percocet. It is true about people that OD on pain killers, most of the time they are addicts that do not even have chronic pain and are taking them for the "high" rather than for any medical benefit. There are the occasions when chronic pain patients have died from taking the opiates/opiods but it is usually the fault of the doctor starting the patient out on too high of a dose, increasing too quickly, or the fault of the patient taking more than prescribed or with other medications that interact. This is why it is SO IMPORTANT to take your medications EXACTLY as prescribed, to let all of your doctors and pharmacists know what you are taking, and there is an EXTREMELY LOW incidence of severe problems in these situations.

brian

 
Old 03-31-2009, 02:54 PM   #15
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Re: Are opioids safe?

Quote:
Originally Posted by XBOX4EVR View Post
imo the only pain killers that are safe are norco or vicodin hydrocodne based pills. when it comes to pain killers there in the weaker class of them, and you rarely if ever hear about people accidentally overdosing on them. But once you get into the oxycondone family "Oxycontin", "Percocet" then youre running a high risk of a accidental od. This is from what i've heard over the years and just in general of watching the news.
The last place any chronic pain patients should be getting info about narcotic pain medication is from the media. They want to sell stories, so they will report the news that "sells". They have unfairly portrayed narcotic medication for far too long.

If anyone has any questions concerning narcotic medication, you should talk to your pain management doctor. Unfortunately many primary care doctors are not well educated pain management/drugs.

10sox

 
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