Considering opioids

Opioids are a powerful prescription-only class of pain relievers related to the granddaddy of all pain relievers, morphine. Also called narcotics, opioids include the natural opium alkaloids, the semisynthetic opioids derived from them, and the fully synthetic opioids. They all bind to opioid receptors found principally in the brain and gastrointestinal tract.

The following includes some common prescription opioids, with their brand name in parentheses:

1 Codeine (Tylenol 3) 1 Hydrocodone (Vicodin) 1 Hydromorphine (Dilaudid) 1 Meperidine (Demerol) 1 Morphine

1 Oxycodone (OxyContin, Percocet, Percodan)

Long-term use of these medications can lead to physical dependence and tolerance; you may need increasingly larger amounts to achieve the same effect. Addiction to opioids can occur if the drugs are misused, taken in larger doses or more often than prescribed, or mixed with other medications.

Table 13-1 lists drugs by classification and schedule, which is the way the Drug Enforcement Administration (DEA) defines the uses of certain drugs. Schedule I drugs have high abuse potential, have no medical use, or haven't been proven to be safe, so we don't list them. Because most opioids fall into Schedules II to IV, we concentrate on them.

Table 13-1

Controlled Substances Classification II—IV

Schedule

Characteristics

Examples (Brand Names)

Schedule II

High potential for abuse. Has an acceptable medical use.

Fentanyl (Sublimaze, Duragesic)

Abuse may lead to severe physical or psychological dependence.

Hydromorphone (Dilaudid)

Morphine (MS Contin, Duramorph)

Oxycodone (OxyContin, Percodan, Percocet, Tylox)

Schedule III

Less abuse potential than Schedule I or II drugs.

Butalbital (Fioricet, Fiorinol)

Has an acceptable medical use.

Codeine (Tylenol #3)

Low to moderate risk of physical or psychological addiction.

Hydrocodone bitartrate (Lorcet, Lortab, Vicodin)

Has an accepted medical use.

May lead to limited physical or psychological dependence.

Dextropropoxyphene (Darvon, Darvocet)

Some doctors are hesitant to prescribe opioids because of the risk of addiction; other doctors are so negative about prescribing opioids that you may leave their office in tears, feeling as if you've been treated like a drug addict for even asking about them. (See the nearby sidebar, "Opioids can lead to dependence and addiction" for more info.)

Finding a doctor who understands pain and is willing to treat it can be an important part of your care. However, doctors who are willing to treat pain are very different from doctors who indiscriminately overprescribe opioids. How can you tell the difference? Your doctor is prescribing responsibly if he

^ Asks about whether or not the drugs are helping, rather than just handing you another prescription

^ Prescribes only a small amount of medication at a time rather than a year's supply

^ Discusses alternative pain-relief methods to try along with the pills il Is concerned about overmedicating you and discusses the signs of over-medication with you

I Listens to your concerns about possible addiction

Many combination pain relievers are opioids mixed with aspirin or acetaminophen. Table 13-2 lists some of the most common pain relievers and their compositions.

Table 13-2 Common Pain Reliever Combos

Drug

Description

Tylenol #3

Acetaminophen 300 mg + Codeine 30 mg

Percocet 7.5

Acetaminophen 325 mg + oxycodone 7.5 mg

Percodan

Aspirin 325 mg + oxycodone 5 mg

Vicodin Acetaminophen 325 mg + hydrocodone bitartrate 5 mg

Vicodin Acetaminophen 325 mg + hydrocodone bitartrate 5 mg m

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