How to use opioids safely
The best time to plan for safe use and disposal of opioids is before you start these medications.By Mayo Clinic Staff
If you are taking opioids or talking with your doctor about this treatment option, now is the time to plan for safe use and disposal of these medications. Practicing caution can mean the difference between life and death for you, your loved ones and even your neighbors.
Opioid painkillers are highly addictive. After just five days of prescription opioid use, the likelihood that you'll develop long-term dependence on these drugs rises steeply — increasing your risk of eventual addiction and overdose. And you don't need a prescription to be at risk. In fact, most people who misuse prescription painkillers report getting them from a family member or friend. Find out what steps to take to keep you and your loved ones safe.
Before you start a course of opioids
Opioids aren't safe to even consider for some people. Your medical history, family history and personal history of substance use all help determine whether opioids are safe for you to try.
Medical conditions that increase your risk of dangerous side effects from opioid medications include:
- Sleep apnea
- Anxiety or depression
Mental health and substance abuse problems that increase your risk of opioid abuse and addiction include:
- History of severe depression or anxiety
- Heavy tobacco use
- Prior drug or alcohol rehabilitation
- Family history of substance abuse
- Personal history of substance abuse
Your doctor will ask about all of these risk factors before prescribing any new opioid medication. Be honest, and don't be afraid to ask your own questions. The safest time to prevent opioid-related problems is before you start these medications.
What to expect from your doctor
The Centers for Disease Control and Prevention (CDC) provides guidance to physicians for safe prescribing of opioid medications. Following the CDC's recommendations, you should expect your doctor to:
- Prescribe the lowest effective dose, for the shortest period needed, when treating acute pain. In most cases, acute pain — such as pain that follows surgery or a bone fracture — is not severe enough to require opioids for more than three days.
- Avoid or delay prescribing opioids for chronic pain. These medications are not often safe or effective for chronic pain unrelated to cancer or cancer treatments. Your doctor should help you evaluate many other therapies — including nonpharmacological treatments and nonopioid medications — before considering a trial of opioids.
- Work with you to establish realistic treatment goals. Your doctor should help you determine how much pain relief you need in order to gain improvements in your ability to function and quality of life. There's no cure for chronic pain, even with drugs as powerful as opioids, and there are risks associated with all pain medications. You and your doctor should be partners in maximizing your enjoyment of life while minimizing medication-related health risks.
Ask you to sign an opioid therapy agreement before you start a long-term course of opioid medications. Typically, these agreements clearly state your responsibilities while using opioid medications. You'll agree to use opioids only as prescribed and to obtain painkillers from only one physician and one pharmacy. You'll acknowledge that you won't receive additional medication until your current prescription runs out, even if your medication is lost or stolen.
You may be asked to submit to periodic urine tests and pill counts. You'll agree to maintain all aspects of your treatment plan — such as physical therapy or behavioral medicine — and to keep all scheduled follow-up appointments. Violation of any of these terms may prompt termination of opioid therapy.
- Schedule regular checkups while you're taking opioids. Expect your doctor to require a follow-up appointment one to four weeks after you start opioid therapy, to evaluate the benefits and risks of these medications for you so far. If you continue taking opioids, your doctor will need to continue seeing you frequently — either with every prescription refill or every three months — for as long as you use these drugs. These visits may include urine tests.
- Help you minimize withdrawal when you stop opioids. If you've taken opioids for chronic pain and determine it's time to stop, your doctor should help you slowly and safely taper off these drugs to avoid potentially severe side effects.
What you can do to safely manage your medications
You play a critical role in ensuring your safety while taking opioids. Your doctor and pharmacist can't help you stay safe if they don't have complete and current information about all your medications.
Take these steps with your health care providers:
Tell all of your providers about all of the drugs you're taking. Opioids interact dangerously with many medications. For example, combining opioids with medications used to treat anxiety or sleep issues can be very harmful, or even deadly.
If you see different doctors, each of them needs to be aware of all the medication you're taking — including over-the-counter medications, such as aspirin, allergy medicine and nutritional supplements. Be honest about your alcohol use and any illegal substances you use.
- Order all your medications through the same pharmacy whenever possible. The pharmacy has systems in place that alert pharmacists to potentially dangerous interactions between the drugs you're taking.
- Read the instructions and warnings on the drug safety information sheet stapled to your prescription. These instructions notify you about potential side effects and help you understand how to check your response to the medication.
- Report side effects to your doctor right away. If you have any side effects, such as constipation, nausea, mood changes or confusion, contact a member of your health care team immediately.
- Check the expiration date on your pill bottle. Medication loses its effectiveness after a certain amount of time, and its effects become unpredictable.
When a medication has expired or you've stopped using it, dispose of it properly.
Oct. 31, 2017
- Prevent opioid misuse. Centers for Disease Control and Prevention. https://www.cdc.gov/drugoverdose/patients/prevent-misuse.html. Accessed Sept. 20, 2017.
- Wallevand KR. Pharmacology. In: Solutions for Living with Chronic Pain. New York, N.Y.: Oxmoor House; 2016.
- Wallevand KR. About pain medications. In: Solutions for Living with Chronic Pain. New York, N.Y.: Oxmoor House; 2016.
- Barbara Woodward Lips Patient Education Center. Questions and answers about opioid pain medications. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2015.
- Bruce BK, et al. Developing a pain control program. In: Mayo Clinic Guide To Pain Relief. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2013.
- Gupta A, et al. Use of opioids in the management of chronic non-cancer pain. https://www.uptodate.com/contents/search. Accessed Sept. 20, 2017.
- Barbara Woodward Lips Patient Education Center. Safe management of controlled substances. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2016.
- Jamison RN, et al. Opioid analgesics. Mayo Clinic Proceedings. 2015;90:957.
- CDC guideline for prescribing opioids for chronic pain. Centers for Disease Control and Prevention. https://www.cdc.gov/drugoverdose/prescribing/guideline.html. Accessed Sept. 20, 2017.
- AskMayoExpert. Opioid prescribing. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017.
- Prescription opioids. Centers for Disease Control and Prevention. https://www.cdc.gov/drugoverdose/opioids/prescribed.html. Accessed Sept. 20, 2017.
- Shah A, et al. Characteristics of initial prescription episodes and likelihood of long-term opioid use — United States, 2006–2015. MMWR. 2017;66:265. https://www.cdc.gov/mmwr/volumes/66/wr/mm6610a1.htm. Accessed Sept. 20, 2017.
- Painter JT, et al. Chronic opioid use in fibromyalgia syndrome. JCR: Journal of Clinical Rheumatology. 2013;19:72.
- Krieger CA (expert opinion). Mayo Clinic, Rochester Minn. Oct. 25, 2017.
- Hooten WM, et al. Incidence and risk factors for progression from short-term to episodic or long-term opioid prescribing: A population-based study. Mayo Clinic Proceedings. 2015;90:850.