Opioids sometimes referred to as narcotics, are a type of drug has been used for centuries for their analgesic agents and also regarded to be the most commonly used pharmacologic agents for the treatment and management of severe pain. These drugs include strong prescription pain relievers such as fentanyl, hydrocodone, tramadol, and oxycodone. Heroin, the illegal drug also falls under the category of Opioids. Your physician or any health care provider may prescribe you Opioids after you have undergone surgery or if you have had any major injury. Cancer patients are also sometimes prescribed with this drug to reduce severe pain and also to relieve some choric pain, health care providers at times prescribe opioids.

Prescription Name and Overview

Opioids are a class of drugs that are naturally found in the opium poppy plant. Some prescription Opioids are directly from plants and others are made by scientists in the laboratory using the same chemical structure.  Opioids contain an element that relaxes the body and relieves pain for which they are used as medicines. When it comes to prescription medications, Opioids are used to heal moderate to severe pain in patients who suffer from post-surgery pain and also who are able to bear the pain of the deadly disease cancer.   Some are also used to treat diarrhea and coughing. They can also be used for non-medical reasons and it is believed to m make people very relaxed or ‘high’. However, it is never right to take Opioids without the prescription of a doctor or a health care provider as it can be highly addictive. As heroin also falls under the category of Opioids, this drug is never prescribed in the United States and in many other countries. Some of the common prescription names are-

•   Oxymorphone (Opana)
•   Codeine
•   Hydrocodone (Vicodin)
•   Oxycodone (OxyContin Percocet)
•   Morphine (Kadian Avinza)
•   Fentanyl  

Generic Name and Overview

 There is more than one generic name of Opioids. They are-

•   Fentanyl (fentanyl extended-release transdermal system)
•   Oxymorphone hydrochloride (oxymorphone hydrochloride extended-release tablets)
• Methadone hydrochloride (methadone hydrochloride tablets, methadone hydrochloride oral solution)
• Morphine sulfate (morphine sulfate extended-release capsules, morphine sulfate extended-release tablets)

When you have a mild headache or even a muscle ache, simple medications available in the pharmacy or over-the-counter medicines are enough to make you feel better. But when the pain is severe and unbearable, your doctor might recommend a strong drug- a prescription Opioids. It is a type of narcotic pain medication that has severe side effects, if not taken as per directed by the physician. 

OTC Name and Overview

Over-the-counter medicines also known as OTC refers to medicines that can be bought without a prescription. Opioids, a narcotic drug has no OTC name for the array of its side effects. In spite of the fact that Opioids relieves strong pain, they are usually not the best way to treat long-term (chronic pain). They can help you if you have short-term pain like the pain after a surgery or for a broken bone. Opioids include full agonists, partial agonists, and antagonists. Too much use of the medications can affect your brain. Often your health care provider may prescribe you Opioids, but with time it is necessary o decrease its dosage. Opioids can be categorized as endogenous (endorphins, enkephalins, dynorphins), opium alkaloids (morphine, codeine), semisynthetic (oxycodone), or synthetic (methadone, fentanyl). The classes of opioids are phenanthrenes, phenylethylamines, and phenylpiperidines

Manufacturer

Opioids are believed to be naturally found in opium (poppy) while its prescription medicine named OxyContin has been manufactured by Purdue Pharma. However, the prescription opioid usage must be limited to rein the problem of opium epidemic even if it won’t end it. The industry as well as the company Purdue Pharma have and will continue to take productive actions to reduce opioids abuse. The company is using the best resources and the premium scientific minds to fight prescription Opioids used and develop new and non-Opioids pain medicines for patients.

Labeled Indications

Opioids are primarily prescribed to reduce moderate to severe pain in patients after a surgery. Also patients in advanced cancer stages are prescribed to take Opioids medication. However, consumption of these medications without the advice of doctors or healthcare provider is right as its overdose can call for numerous health risks. 

Active Ingredients

Affected Opioids drugs, which include the generic name and branded products, are formulated with the active ingredients fentanyl, hydromorphone, methadone, morphine, oxycodone, and oxymorphone. Pain relief medicines also termed as ‘analgesics and ‘painkillers’ are regulated by the Food and Drug Administration (FDA). Some of the analgesics, including Opioids analgesics, act on the body’s central nervous system and also the body’s peripheral to decrease or block sensitivity to pain. Pain medications are safe as well as effective when used as per the advice of the physician. 

Misuse of these products can be extremely harmful and can even lead to death.  Consumers who are taking pain relief medications must never take it without the concern of the doctor. If any measuring tool is provided with the medicine, you must ensure the measurement before consuming. It is never a noble thing to share your pain relief medicines with anyone. It is only your health care professional and his/her prescription that will decide if the medicine is safe for someone.  In case you are taking Opioids, you must consider some of the effects that mainly include drowsiness. Do not drive or use any machinery that may lead to life risk. The dose of an Opioids medication should be cross-checked with your physician as an overdose might lead to death. 

What Is It Used For?

Despite the fact that there are numerous adverse effects of Opioids, there are also some clinical uses as well. Let’s have a look-

Analgesia:

Opioids analgesic seems to be extremely effective in managing and treating severe pain. Often it is used in the management of pain in cancer patients or pain associated with other illness. However, continuous use of potent opioids analgesics may concern about tolerance and dependence. During obstetric labor, often opioids are used to control the pain. In addition, Opioids analgesics are often given during severe pain associated with binary and renal conic.

Acute Pulmonary Edema:

The use of intravenous morphine provides relief of dyspnea from pulmonary edema associated with left ventricular failure. Proposed mechanisms of actions include decreased anxiety levels, reduced awareness of shortness of breath and reduced cardiac preload and afterload.

Diarrhea:

Opioids that consist of synthetic opiates are often used to control diarrhea due to their selective GI effects. Loperamide and diphenoxylate are some of the examples of these agents.

Cough:

Cough can also be controlled with the use of Opioids drugs. However, with the formulation of newer agents that are non-addictive, opioids use have decreased. 

Anesthesia:

Opioids are frequently used as a drug before surgery and anesthesia because of their anxiolytic, sedative and analgesic properties. During cardiac and other types of high-risk surgeries, Opioids are commonly utilized to minimize cardiovascular depression. 

How Does it Work?

Opioids attach to proteins called Opioids receptors on nerve cells in the brain, gut, spinal cord and also other parts of the body. When this happens, Opioids block pain messages sent from the body through the spinal cords to the brain. While it can effectively reduce pain, there are certain risks associated with Opioids and this drug can be highly addictive. The risk of addiction is comparatively higher when Opioids are taken to control chronic pain over a long period of time. 

What are the Approved Uses?

Opioids are commonly prescribed because they are effective to reduce moderate to severe pain. If used properly, Opioids such as morphine have long been known to help severe pain that follows surgery and also alleviates the pain in patients with advanced cancer stage. However, it is always suggested to take Opioids as per directed by the physician.

Production Anecdotes / History

From the earliest civilization in history the use of opiates in treating pain has been recorded. As opioid was naturally derived from opium in poppy plants, its earliest reference dates back to 3400 BC when poppies where cultivated in Mesopotamia. In 1806, a German Chemist named Adam Serturner isolated a substance from opium, which he named ‘morphine’ and in the following years and even today, Morphine became one of the prime drugs for the doctors of the US for treating anxiety and pain other respiratory problems. 

The history of Opioids epidemic is terrible and all started to take place since 1775 after opium made its way in 1775 in the US during 1860s opioid was extensively used to treat a soldier in the Civil War. By 1800s, there was a sharp rise in Opioids addiction. In 1910, the use of Opioids took a wild face as Americans in 1910 was extensively crushing these pills for pleasure. In the next century, Opioids took its transition from pills to heroin and by 2010, its use was the maximum. According to the present day reports, there are 142 overdose deaths a day in the US and doctors and scientists are trying hard enough to reduce the consumption of this drug.

Precautions

There are certain things to know before taking this type of medication. And again, without the direction of your health care provider, it is never the right thing to start taking opioids. However, let’s have a look at some necessary precautions to be taken before starting Opioids-

•   Whether you are under medication for certain other health issues
•   Do you drink alcohol?
•   It is necessary to tell your physician your medical history and if anyone in your family has a history of addiction to a drug or misuse of other medicines.
•   If you are pregnant or planning to become pregnant

Long-Term Use Considerations

Opioids are an effective pain reliever but it is better to take this medication only for treating short-term pain. Taking this type of medication in the long-run can lead to certain side effects and can also become an addiction. According to different clinical reports, an increasing number of deaths are due to the drug overdose and in most cases, patients who were prescribed Opioids for long-term chronic pain were more in number.

Drug Interactions

Can Interact with the Following

•   Anti-seizure medications, such as carbamazepine (Carbatrol, Tegretol, others)
•   Certain antidepressants
•   Alcohol
•   Certain antibiotics, including clarithromycin (Biaxin)
• Certain antiretroviral drugs used for HIV infection, including atazanavir (Reyataz), indinavir (Crixivan), ritonavir (Norvir) and others
• Certain antifungals, including itraconazole (Onmel, Sporanox), ketoconazole and voriconazole (Vfend)
•   Drugs for sleeping problems, such as zolpidem (Ambien, Intermezzo, others)
•   Sedatives, such as diazepam (Valium)
•   Muscle relaxers, such as cyclobenzaprine (Amrix)
•   Drugs used to treat psychiatric disorders, such as haloperidol (Haldol)
•   Other opioid medications

Can’t Interact with the Following

No record has been found about the drugs or medications that are enabled to interact with Opioids.

When to Stop Taking

Opioids are very powerful painkillers. Despite the facts that there have been many reports of drug misuse or overdose, they still persist to be one of the most effective options for severe short-term pain. If you have been under opioids medication for less then two weeks, you should be able to simply stop these medications as soon as your prescribed pills are over. If you have taken this medication for more then two weeks you may also need to stop the medicine at the earliest to prevent serious consequences. Common signs that indicate it is time to get off opioids are-

•   Some serious side effects like drowsiness, confusion, euphoria, slowed breathing
•   Reduced pain relief from the same dose of medication over time.
•   Behaviors that raise concern about addiction, abuse, and misuse.

Long-Term Side Effects

•   Constipation
•   Drowsiness
•   Nausea and vomiting

FDA Warnings (History Of)

Opioids medication has always been under the limelight of the Food and Drug Administration for containing various elements that are related to health risks, deaths, and deception. Amongst numerous warning letters given by FDA, recently a drug distributor McKesson was accused of allegedly shipping ‘illegitimate’ opioid products. Also in 2018, the FDA issued a statement warning veterinarians that some pet owners may be using their animals to get prescriptions for opioids drugs.

Other Common Side Effects

Common side effects as per the reports, surveys and research papers in WebMD and other scientific journals include-

•   Sedation
•   Dizziness
•   Nausea
•   Vomiting
•   Constipation
•   Physical dependence
•   Tolerance
•   Respiratory Depression

Lawsuits

FDA is taking important steps to address the Opioid crisis yet numerous people and families have already been affected by the usage of these drugs, Even many people still continue to face serious risks as the opioid epidemic continues to increase. The medicines have served numerous lawsuits and even though there can be no compensation paid for the loss of victims of the Opioids drug abuse, there may be some legal options for the survivors and their families-

•   Seeking Compensation for medical bills lost earnings, suffering, and pain
•   Holding negligent pharmaceutical companies accountable. 

One of the most recent examples of opioids lawsuit is that of Purdue Pharma, the drug maker of OxyContin, against which numerous lawsuits have been filed by hundreds of counties, tribes, and states.

Tracy Everhart

Tracy Everhart is the Editor for Drug Law Journal. A highly-trained and certified medical professional, Tracy is also an accomplished medical writer. After spending years on the front lines of the medical profession, Tracy now devotes her expertise and skills to researching and reporting on new drugs and devices that enter the market, as well as their side-effects and the real-life stories involved. Prior to joining Drug Law Journal, Tracy wrote for benchmark online healthcare resources focused on families and, in particular, women’s health issues. Tracy holds post-graduate degrees from both the American College of Healthcare Sciences and the Yale School of Nursing. She is also a graduate of both Hampshire College, where she studied microbiology and the University of South Carolina school of nursing.