Discussions that mention duragesic

Pain Management board


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