Opioids are a class of prescription medication meant to manage pain and improve a person’s activity level. They’re usually meant to be taken for a short time while a person recovers from an injury or surgery.
Opioids also are highly addictive. A person with a one-day prescription has a 6% chance of still taking opioids a year later. More than 10 million Americans misused an opioid last year. So it’s important to have a plan and support in place when a bottle of opioids comes home.
“It should be a partnership with everyone involved: the patient, the loved ones and the doctor,” says Holly Geyer, M.D., an internal medicine doctor at Mayo Clinic in Arizona and author of “Ending the Crisis,” a new book from Mayo Clinic Press.
Opioids include prescription medicines such as morphine, oxycodone (Oxycontin, Roxicodone), hydrocodone plus acetaminophen (Lortab), hydromorphone (Dilaudid), tramadol (Ultram) and fentanyl (Actiq, Abstral, Fentora). Opioids also include nonprescription drugs such as heroin.
Dr. Geyer suggests that people prepare to have opioids in the home and watch for signs of potential for misuse.
Talk to your health care providers
Because opioids are powerful substances, consider your health care providers and pharmacist as your teammates. Tell them about:
- All medications and supplements you use.
- Any substance use disorders, anxiety or mood disorders in your personal or family medical history, now or in the past. Opioids can make these conditions worse.
- Any other medical conditions you have, particularly any affecting the heart or lungs.
Fill all your prescriptions at one pharmacy so the pharmacist can watch for possible drug interactions. Generally, you shouldn’t take opioids with medicines or substances that make you tired, such as muscle relaxants, alcohol or benzodiazepines. Ask your doctor or pharmacist if you’re not sure.
Make a plan
Don’t leave opioid bottles on counters or in places where others could easily get them. Plan ahead for where you will keep them so they are out of reach of children, vulnerable adults and pets.
Similarly, plan how you will dispose of remaining medication after your pain has eased. Keeping opioids around the house is not safe and increases the chances that they may be misused.
Ask your pharmacist where to find boxes where you can drop off unused medication. Your pharmacist also might have special medication-deactivating bags for pill disposal.
Appoint an advocate
Ask a trusted household member or other friend or family member to help you manage your medication. You might invite this person to speak with you and your doctor or pharmacist about signs of opioid overuse. Your advocate should voice any concerns about your opioid use.
Advocates can watch for signs of opioid dependence such as:
- Appearing to be unusually energetic or the opposite: tired and sedated.
- Sleeping a lot more or less than usual.
- Taking opioids “just in case” rather than for severe pain.
- Having mood changes.
- Having changes sleep patterns.
- “Losing” medication, so a new prescription must be written.
- Getting into dangerous situations.
- Having decreased work or school performance.
Advocates should voice concerns, Dr. Geyer says. They can consider saying:
- Maybe we should do a pill count. How many of those opioids are left?
- I’m really concerned about your recent behaviors. You’re not talking to me much. You’re sleeping during the day. You’re missing family activities.
- I want to talk with your doctor and you about this. I’m scared that it’s the opioids.
“These are how those conversations start,” Dr. Geyer says. “And you’ve got to be bold. No one wants to accuse a family member. But the choice is speaking up versus dealing with the long-term consequences of uncontrolled addiction. Be proactive instead of reactive.”
Watch yourself
Opioids affect the pleasure center of the brain, which can make the whole body want more. If you find yourself craving that next pill or taking opioids just in case pain strikes rather than because severe pain is present, talk to your advocate or your doctor. It might be a sign you are becoming addicted and should stop taking opioids.
Prioritize nonopioid pain relievers
Nonopioid pain relievers such as acetaminophen (Tylenol, others) and ibuprofen (Advil, Motrin IB, others) are safer and often as effective as opioids for managing pain. Your doctor might recommend scheduling nonopioid pain relievers and using opioids only for breakthrough pain.
Use nonmedication pain management techniques
Engaging in soothing activities can help calm the central nervous system. This helps ease both pain and cravings. It can also help put pain into perspective.
Try:
- Breathing in and out slowly.
- Meditating or praying.
- Visualizing a calm, peaceful, healing place.
- Practicing yoga or tai chi.
- Going for a walk or doing other physical activity.
- Stretching.
- Establishing healthy sleeping habits.
- Getting a massage.
- Having acupuncture.
Ask your pharmacist about naloxone
Naloxone (Evzio, Narcan) is a medicine that quickly reverses overdose from opioids. People with an opioid prescription for longer than 30 days, a history of addiction, or a health condition such as liver, lung, heart or kidney problems will often have naloxone prescribed along with opioids, Dr. Geyer says.
“For those without those risk factors, most states now have naloxone available to patients and families at pharmacies without a patient-specific prescription,” Dr. Geyer says. “It never hurts to have the drug handy, so for that reason I recommend everyone with opioids present in the house check with the pharmacy to see if they are eligible to receive.”
Relevant reading
Ending the Crisis
An authoritative guide to understanding the current opioid crisis in America and how it can be solved.
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