Sunday, April 26, 2020
Opioids are substances that act on your opioid receptors to produce morphine-like effects on your body. Medically they are primarily used for pain relief, including anesthesia, suppression of diarrhea, replacement therapy for opioid use disorder, reversing opioid overdose, suppressing cough, as well as executions in the United States.
Extremely potent opioids such as carfentanil are approved only for veterinary use. Opioids are also frequently used non-medically for their euphoric effects or to prevent withdrawal.
Opioids are a class of drugs that include the illegal drug heroin. How ever, synthetic opioids such as fentanyl, and pain relievers are available legally by prescription. Some of these legally accepted opioids called narcotics are oxycodone (OxyContin), hydrocodone (Vicodin), codeine, morphine, and many others.
The weak opioid codeine, in low doses combined with one or more other drugs, is commonly available without a prescription and can be used to treat small or mild pain. Other opioids are usually reserved for the relief of moderate to severe pain.
Opioids are effective for the treatment of acute pain such as surgery. For immediate relief of moderate to severe acute pain, opioids are frequently the treatment choice due to their rapid onset, efficacy, and reduced risk of dependence. However, a new report showed a clear risk of prolonged opioid use when opioid analgesics are initiated for acute pain management following surgery or trauma.
They have also been found over the years to be important in palliative care to help with the severe, chronic, disabling pain that may occur during terminal conditions such as cancer, and degenerative conditions such as rheumatoid arthritis. In many cases, opioid drugs are a successful long-term care strategy for those with chronic cancer pain.
Codeine was once viewed over the years as the "gold standard" in cough suppressants, but this position is now questioned. Some recent placebo-controlled trials have found that it may be no better than a placebo for some causes such as acute cough in children. Plus, it is not recommended for children.
Additionally, there is no evidence that hydrocodone is useful for children. Similarly, a 2012 Dutch guideline regarding the treatment of acute cough does not recommend the use of codeine. The opioid analog dextromethorphan long claimed to be as effective as a cough suppressant as codeine, has similarly demonstrated little benefit in several recent studies.
Opioids may play a helping role shortness of breath particularly in advanced diseases such as cancer and COPD among others.
Opioid-induced hyperalgesia (OIH) has been evident in patients after chronic opioid exposure.
In cases of diarrhea-predominate irritable bowel syndrome, opioids may play a vital role to suppress diarrhea. Loperamide is a peripherally selective opioid available without a prescription used to suppress diarrhea.
The ability to suppress diarrhea also produces constipation when opioids are used beyond several weeks. Naloxegol, a peripherally-selective opioid antagonist is now available to treat opioid-induced constipation.
Medications that bind to opioid receptors are increasingly being prescribed for the treatment of multiple and diverse chronic painful conditions. Their use for acute pain or terminal pain is well accepted. Their role in the long-term treatment of chronic noncancer pain is, however, controversial for many reasons. One of the primary reasons is the well-known phenomenon of psychological addiction that can occur with the use of these medications.
Abuse and diversion of these medications is a growing problem as the availability of these medications increases and this public health issue confounds their clinical utility. Also, the extent of their efficacy in the treatment of pain when utilized on a chronic basis has not been definitively proven. Lastly, the role of opioids in the treatment of chronic pain is also influenced by the fact that these potent analgesics are associated with a significant number of side effects and complications.
It is these phenomena that are the focus of this review. Common side effects of opioid administration include sedation, dizziness, nausea, vomiting, constipation, physical dependence, tolerance, and respiratory depression. Physical dependence and addiction are clinical concerns that may prevent proper prescribing and in turn inadequate pain management. Less common side effects may include delayed gastric emptying, hyperalgesia, immunologic and hormonal dysfunction, muscle rigidity, and myoclonus.
The most common side effects of opioid usage are constipation (which has a very high incidence) and nausea. These 2 side effects can be difficult to manage and frequent tolerance to them does not develop; this is especially true for constipation. They may be severe enough to require opioid discontinuation and contribute to under-dosing and inadequate analgesia. Several clinical trials are underway to identify adjunct therapies that may mitigate these side effects.
Switching opioids and/or routes of administration may also provide benefits for patients. Proper patient screening, education, and preemptive treatment of potential side effects may aid in maximizing effectiveness while reducing the severity of side effects and adverse events. Opioids can be considered broad-spectrum analgesic agents, affecting a wide number of organ systems and influencing a large number of body functions.
Fentanyl is a synthetic opioid pain reliever and is found in powder or patches. It is many times more powerful than other opioids and is approved for treating severe pain, advanced cancer pain. Illegally made and distributed fentanyl has been on the rise in several states.
Heroin is an illegal opioid. Heroin use has increased across the U.S. among men and women, most age groups, and all income levels.