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Narcotic analgesics

Written on February 28, 2018 by C. Fookes, BPharm

Medically reviewed on February 28, 2018 by C. Fookes, BPharm

Other names: narcotics, opiates, opioid analgesics, opioids

What are narcotic analgesics?

Narcotic analgesics are a class of medicines that are used to provide relief from moderate-to-severe acute or chronic pain. They may also be called opiates, opioid analgesics, or narcotics. Analgesic is another name for a medicine that relieves pain.

Narcotic analgesics are one of the most widely used analgesics for pain relief; however, they have been overused, overprescribed, and misused which has resulted in more than two million people in the U.S. alone having a substance misuse disorder involving prescription narcotic analgesics.

Narcotic analgesics work by binding to opioid receptors, part of the opioid system that controls pain, pleasurable and addictive behaviors. Opioid receptors are more abundant in the brain and spinal cord but are also located elsewhere in the body such as the stomach and the lungs. The main opioid receptor that narcotic analgesics bind to is the mu receptor.

What are narcotic analgesics used for?

In the past, narcotic analgesics have been used for all types of pain, which may explain why there are so many people addicted to them today.

The most appropriate use of narcotic analgesics is for the relief of short-term, intense pain, such as that occurring immediately after surgery or due to a medical condition.

Narcotic analgesics are also appropriate for the relief of pain due to cancer, or for palliative care or end-of life care. However, they should only be considered to treat other types of chronic pain under strict conditions and with close monitoring.

What are the differences between narcotic analgesics?

Narcotic analgesics differ in their structure, potency, and the way they are absorbed, distributed, metabolized and excreted within the body.

Some, like morphine and codeine were originally derived from plants. Others, such as heroin, hydrocodone, hydromorphone, oxycodone and oxymorphone were made by modifying morphine and are called semi-synthetic. There are three main classes of opioids – those that are structurally like morphine (the phenanthrenes), those that resemble fentanyl (the phenylpiperidines), and those that resemble methadone (the phenylheptylamines).

Different narcotic analgesics have different potencies, based on how strongly they bind to the opioid receptor (for example, fentanyl is 80 to 100 times stronger than morphine). This means that dosages for one narcotic may be significantly different from another. Although conversion charts exist (these tell you what dose of a narcotic compares to the equivalent analgesic dose of morphine), these are only at best a guide because other variables, such as an individual’s genetics, also play a part in how a person responds to a narcotic.

If a narcotic analgesic is deemed appropriate, codeine or tramadol should be tried first if the pain is mild-to-moderate. If the pain is unresponsive to these analgesics, or for more severe pain, then hydromorphone, morphine, or oxycodone should be considered. Fentanyl and methadone should only be used for severe pain that is unresponsive to other narcotic analgesics.

Common narcotic analgesics available in the U.S. include:

Name Route Onset of effect Duration of effect
alfentanil Intravenous (IV) 90 seconds 45-60 mins
codeine Oral 15-60 mins 3-4 hours
fentanyl IV Immediate 0.5-1h
Intramuscular (IM) 7-8 mins 1-2 hours
Buccal (through the gums)
Sublingual (SL)
5-15mins 4-6 hours
Transdermal patch (via the skin) 6h 72-96 hours
hydrocodone Oral 10-20 minutes 4-8 hours
hydromorphone Oral 15-30 mins 3-4 hours
IV 5 mins 3-4 hours
methadone Subcutaneous (SC) (under the skin) 15 mins 3-4 hours
morphine Oral 30-60 mins 3-6 hours (immediate-release)
8-24 hours (extended-release)
IV/SC 5-10 mins 4 hours
oxycodone Oral 10-15 mins 3-6 hours
oxymorphone Oral 30-60 mins (immediate-release)
1-2 hours (extended-release)
4-6 hours (immediate-release)
12 hours (extended-release)
IM/IV/SC 5-10 mins 3-6 hours
tramadol Oral 30-60 mins (immediate-release)
1-2 hours (extended-release)
4-6 hours (immediate-release)
24 hours (extended-release)

Are narcotic analgesics safe?

There are serious risks associated with narcotic analgesics including respiratory depression (unusually slow and shallow breathing), opioid-use disorder, and potentially fatal overdose.

Opioid-use disorder is defined as the repeated occurrence of at least two out of 11 specific opioid-associated problems, including using opioids in increased amounts or for longer than intended; continued use despite interference with daily activities; or still using while in hazardous situations. Severe opioid-use disorder is defined as a cluster of 6 or more problems and it can affect people from all educational and socioeconomic backgrounds.

Narcotic analgesics are potentially addictive and the risk of becoming emotionally and physically dependent on them increases the more you take and the longer you take them for. When prescribed by a doctor and used for short periods of time, such as for less than five days for pain relief after surgery, the risk of becoming addicted to narcotic analgesics is relatively low.

The number of fatal overdoses from opioids continues to rise and this has resulted in government officials introducing new legislation to further restrict the prescribing of opioids. More than 42,000 people died in 2016 because of an opioid overdose; 40% of these deaths involved a prescription narcotic analgesic.


When taken exactly as prescribed by a doctor, for short periods of time, for the relief of severe pain, and under strict monitoring, narcotic analgesics are considered acceptable to use. However, they may still be associated with some severe side effects, despite proper use.

What are the side effects of narcotic analgesics?

Narcotic analgesics have many side effects, although people with cancer or terminal illness taking narcotics for long periods of time may become tolerant to some of these side effects.

Drowsiness, sleepiness, or dizziness is common with most narcotic analgesics. This can affect driving or a person's ability to operate machinery and perform other hazardous tasks. Alcohol may potentiate these effects.

Other commonly reported side effects include:

Withdrawal symptoms may occur when people who have been taking narcotic analgesics abruptly stop taking them. Symptoms are like having the flu, and may include body aches, chills, depression, diarrhea, goose-bumps, headaches, high blood pressure, insomnia, irritability, a runny nose and sweats. Withdrawal symptoms usually last about a week.

References

  1. Opioid Addiction. 2016 Facts & Figures. American Society of Addiction Medicine.  https://www.asam.org/docs/default-source/advocacy/opioid-addiction-disease-facts-figures.pdf
  2. Drewes AM, Jensen RD, Nielsen LM, et al. Differences between opioids: pharmacological, experimental, clinical and economical perspectives. British Journal of Clinical Pharmacology. 2013;75(1):60-78. doi:10.1111/j.1365-2125.2012.04317.x.
  3. Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain Michael G. DeGroote. National Pain Centre. McMaster University. http://nationalpaincentre.mcmaster.ca/opioid_2010/cgop_b02_r08.html
  4. Fentanyl Effentora 100 mcg Buccal Tablets. EMC. TevaPharmaBC https://www.medicines.org.uk/emc/product/5400/smpc#PHARMACOKINETIC_PROPS
  5. Rational Opioid use. Stanford Education 2008. http://ether.stanford.edu/ca1/text08/i.pdf.
  6. http://www.pharmacytimes.com/publications/issue/2011/june2011/an-overview-of-opioids

 

List of Narcotic analgesics:

Filter by:
Drug NameView by: Brand | Generic Reviews Avg. Ratings
Astramorph PF (Pro, More...)
generic name: morphine
0 reviews
   
10
Dazidox (More...)
generic name: oxycodone
1 review
   
10
Ionsys (Pro, More...)
generic name: fentanyl
0 reviews
   
10
Lazanda (Pro, More...)
generic name: fentanyl
1 review
   
10
Numorphan (Pro, More...)
generic name: oxymorphone
0 reviews
   
10
Onsolis (Pro, More...)
generic name: fentanyl
0 reviews
   
10
Oxyfast (More...)
generic name: oxycodone
4 reviews
   
10
Palladone (Pro, More...)
generic name: hydromorphone
1 review
   
10
Probuphine (Pro, More...)
generic name: buprenorphine
2 reviews
   
10
Roxanol (More...)
generic name: morphine
0 reviews
   
10
Roxanol-T (More...)
generic name: morphine
0 reviews
   
10
Roxicodone Intensol (More...)
generic name: oxycodone
5 reviews
   
10
Meperitab (More...)
generic name: meperidine
3 reviews
   
9.8
Methadone Diskets (More...)
generic name: methadone
30 reviews
   
9.4
Actiq (Pro, More...)
generic name: fentanyl
16 reviews
   
9.2
Fentora (Pro, More...)
generic name: fentanyl
14 reviews
   
9.2
Subutex (More...)
generic name: buprenorphine
88 reviews
   
9.2
Demerol (Pro, More...)
generic name: meperidine
60 reviews
   
9.1
Dolophine (Pro, More...)
generic name: methadone
21 reviews
   
9.1
Infumorph (Pro, More...)
generic name: morphine
2 reviews
   
9.0
Methadose (Pro, More...)
generic name: methadone
36 reviews
   
9.0
Opium Deodorized (More...)
generic name: opium
2 reviews
   
9.0
Roxicodone (Pro, More...)
generic name: oxycodone
58 reviews
   
9.0
Paregoric (More...)
generic name: opium
8 reviews
   
8.7
OxyContin (Pro, More...)
generic name: oxycodone
268 reviews
   
8.6
Subsys (Pro, More...)
generic name: fentanyl
12 reviews
   
8.6
Dilaudid (Pro, More...)
generic name: hydromorphone
282 reviews
   
8.5
Oxydose (More...)
generic name: oxycodone
1 review
   
8.5
Zohydro ER (More...)
generic name: hydrocodone
47 reviews
   
8.4
Buprenex (Pro, More...)
generic name: buprenorphine
4 reviews
   
8.3
Duragesic (Pro, More...)
generic name: fentanyl
71 reviews
   
8.3
Kadian (Pro, More...)
generic name: morphine
46 reviews
   
8.1
Opana (Pro, More...)
generic name: oxymorphone
89 reviews
   
8.1
Sublimaze (Pro, More...)
generic name: fentanyl
6 reviews
   
8.1
MS Contin (Pro, More...)
generic name: morphine
89 reviews
   
8.0
Avinza (Pro, More...)
generic name: morphine
32 reviews
   
7.9
Fentanyl Transdermal System (More...)
generic name: fentanyl
72 reviews
   
7.9
Exalgo (Pro, More...)
generic name: hydromorphone
33 reviews
   
7.8
Levo-Dromoran (Pro, More...)
generic name: levorphanol
3 reviews
   
7.8
OxyIR (More...)
generic name: oxycodone
5 reviews
   
7.8
Opana ER (Pro, More...)
generic name: oxymorphone
83 reviews
   
7.7
Abstral (Pro, More...)
generic name: fentanyl
2 reviews
   
7.6
Nubain (Pro, More...)
generic name: nalbuphine
26 reviews
   
7.5
Rybix ODT (Pro, More...)
generic name: tramadol
0 reviews
   
7.5
Stadol (Pro, More...)
generic name: butorphanol
43 reviews
   
7.5
Ultram ER (Pro, More...)
generic name: tramadol
32 reviews
   
7.5
Ultram ODT (More...)
generic name: tramadol
11 reviews
   
7.5
Nucynta ER (Pro, More...)
generic name: tapentadol
66 reviews
   
7.3
Sublocade (Pro, More...)
generic name: buprenorphine
3 reviews
   
7.3
Darvon (More...)
generic name: propoxyphene
7 reviews
   
7.2
Dilaudid-HP (Pro, More...)
generic name: hydromorphone
9 reviews
   
7.2
Butrans (Pro, More...)
generic name: buprenorphine
167 reviews
   
6.8
Nucynta (Pro, More...)
generic name: tapentadol
227 reviews
   
6.4
Ultram (Pro, More...)
generic name: tramadol
212 reviews
   
6.4
Duramorph (Pro, More...)
generic name: morphine
4 reviews
   
6.2
Ryzolt (Pro, More...)
generic name: tramadol
11 reviews
   
6.2
Oramorph SR (Pro, More...)
generic name: morphine
5 reviews
   
6.1
Talwin (More...)
generic name: pentazocine
6 reviews
   
5.7
Alfenta (More...)
generic name: alfentanil
0 reviews
   
5.5
ConZip (Pro, More...)
generic name: tramadol
1 review
   
5.2
Oxaydo (Pro, More...)
generic name: oxycodone
8 reviews
   
4.9
Xtampza ER (Pro, More...)
generic name: oxycodone
34 reviews
   
4.7
Hysingla ER (Pro, More...)
generic name: hydrocodone
74 reviews
   
4.4
Belbuca (Pro, More...)
generic name: buprenorphine
62 reviews
   
4.0
MorphaBond ER (Pro, More...)
generic name: morphine
1 review
   
1.0
Vantrela ER (More...)
generic name: hydrocodone
0 reviews
   
1.0
Arymo ER (Pro, More...)
generic name: morphine
0 reviewsAdd rating
DepoDur (More...)
generic name: morphine liposomal
0 reviewsAdd rating
ETH-Oxydose (More...)
generic name: oxycodone
0 reviewsAdd rating
Methadose Sugar-Free (More...)
generic name: methadone
0 reviewsAdd rating
Oxecta (Pro, More...)
generic name: oxycodone
0 reviewsAdd rating
RMS (More...)
generic name: morphine
0 reviewsAdd rating
RoxyBond (Pro, More...)
generic name: oxycodone
0 reviewsAdd rating
Sufenta (Pro, More...)
generic name: sufentanil
0 reviewsAdd rating
Ultiva (Pro, More...)
generic name: remifentanil
0 reviewsAdd rating
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