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.
How to safely dispose of unused medication
Don't leave unused opioids in your medicine cabinet "just in case." A large part of the opioid abuse crisis is driven not by the people who were originally prescribed the drugs, but by people taking medications that don't belong to them. If you're done with your painkillers, it's very important to dispose of them as quickly and properly as possible.
Don't give your unused medications to your friends and don't throw them away. While some types of prescription drugs can be disposed of in your household trash, the FDA says that opioids are too dangerous to go out with your garbage because even one dose to the wrong person can sometimes be fatal.
To pass your medications into safe hands, contact an organization with an authorized take-back program, such as:
- Your local law enforcement agency. Many have medicine takeback programs.
- Your trash and recycling service. Ask about medication disposal options and guidelines for your area.
- The Drug Enforcement Administration (DEA). DEA staff can point you to an authorized site that collects unused medicines. This may include retail, hospital or clinic pharmacies, law enforcement locations, or even mail-back programs.
Flushing your unused opioid medication is also recommended in some cases. According to the the U.S. Food and Drug Administration (FDA), flushing should be considered when a medication cannot be safely and securely stored until disposal via a take-back program, or when there are risks in waiting to do so. The FDA's "flush list" includes oxycodone, hydrocodone, fentanyl and many other opioids.
Fentanyl patches can be deadly to small children and should be flushed as soon as you take them off your skin. Fold the sticky sides together before flushing.
If your medication isn't on the FDA's flush list and there's no takeback program in your area, consult your pharmacist for guidance.
Signs of trouble
Opioids can affect your thinking and judgment. Even when you take an opioid medication as prescribed, you might make decisions too quickly, without thinking things through. You may think you're OK and you're making good decisions when you're not. You may take risks and put yourself and others in danger. These are signs that you need to make a plan with your doctor to safely taper off your medications.
In addition, if you or a loved one is currently taking opioid medications, stay on the lookout for signs of trouble. Signs of opioid abuse include:
- Regularly taking more than the prescribed dose of medication
- Taking pain medication "just in case," even when you're not in pain
- Mood changes
- Borrowing medication from other people, or using medication prescribed for someone else
If taking opioids becomes the center of your life, tell your doctor how the medication is affecting you.
Stopping opioids safely
Don't try to go off opioids cold turkey, on your own. That's a recipe for failure and puts you at risk of serious health consequences. If you've become dependent on opioids or prefer to stop using them, ask your doctor to help you taper off. There are many nonopioid alternatives to help you manage your pain.
Vivien Williams: Opioid painkiller addiction can destroy lives. The CDC reports that in 2014, 2 million Americans abused or were dependent on painkillers, such as hydrocodone, oxycodone and methadone.
Mike Hooten, M.D. (Anesthesiology, Mayo Clinic): The most important first step is recognizing you have a problem.
Vivien Williams: Mayo Clinic pain management specialist Dr. Mike Hooten says the second step is to talk to the doctor who prescribed the medication.
Michael Hooten, M.D.: The medication, under medical direction, can be gradually tapered and then at the same time, other pain therapies can be introduced if needed. And, finally, you need to be referred to the appropriate addiction specialist.
Vivien Williams: Dr. Hooten says breaking free from opioids is not easy. But, unlike alcohol withdrawal, which can be life threatening, …
Michael Hooten, M.D.: Acute opioid withdrawal is a non-lethal syndrome. It's very, very uncomfortable, but not necessarily associated with death.
Vivien Williams: Every day 78 people die from an opioid overdose. Experts urge anyone who is addicted to get help. It can save your life. For the Mayo Clinic News network, I'm Vivien Williams.
Mike Hooten, M.D. (Anesthesiology, Mayo Clinic): Any prescription medication should never be shared, especially opioids.
Vivien Williams: Mayo Clinic pain management expert Dr. Mike Hooten gives two big reasons why you should not share opioid pain medication.
Mike Hooten, M.D.: They are dangerous. They could have adverse effects that the individuals may not even recognize.
Vivien Williams: Plus, sharing opioids is against the law.
Vivien Williams: A study shows 1 out of 5 people who were prescribed opioids shared them, mostly to help friends or family with pain. And almost half of the people in the study did not know what to do with leftover pills.
Mike Hooten, M.D.: My recommendation to patients is if there's any medication left over at all, it needs to be disposed of. It needs to be out of the house. This is not a medication you want sitting in the cabinet for some use in the future.
Vivien Williams: Dr. Hooten says rules about medication disposal vary state by state. Check out fda.gov to find out how to get rid of medication safely. For the Mayo Clinic News Network, I'm Vivien Williams.
Vivien Williams: How many opioid painkiller prescriptions are written in the US every year? More than 250 million. An estimated 4% of adults are being treated with opioids for chronic non-cancer pain, typically back pain and musculoskeletal pain.
Michael Camilleri, M.D. (Gastroenterology, Mayo Clinic): We know that about 40 to 80 percent of people who receive opioids develop G.I. symptoms, and the most common G.I. symptom is constipation.
Vivien Williams: Mayo Clinic Dr. Michael Camilleri says being constipated is not dangerous, but it can be very uncomfortable.
Michael Camilleri, M.D.: Sometimes that discomfort can be interpreted as abdominal pain.
Vivien Williams: Prompting people to increase their dose, making the situation worse.
Michael Camilleri, M.D.: The two main reasons why opioids cause constipation are, first, the opioid kind of paralyzes the nerves and muscles.
Vivien Williams: Second, they rev up your intestines to absorb excess liquid. So, what can you do about it? Eat fiber-rich foods, drink water and, if need be, try an over-the-counter laxative, even if you are prescribed opioids for a short period, like after an injury, fracture or operation. For severe cases, prescription medication may help.
Vivien Williams: Dr. Camilleri says the best remedy is to work with your health care provider to find alternatives to opioids. For the Mayo Clinic News Network, I'm Vivien Williams.
April 24, 2019
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