Top Truths About Narcotic Painkiller Meds
Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on March 29, 2021.
Over-the-Counter Painkillers or Narcotics: The Choices Are Numerous
Opioids are in the news daily, and the statistics on overdoses, emergency room admissions, and deaths are shocking. It's important to understand opioids, the good, bad, and the ugly.
Strong painkillers like opioids, also known as narcotics, require a prescription and have special DEA rules for dispensing by your pharmacist.
Opioid examples include medicines like:
In contrast, over-the-counter pain medicines, also called “OTC” or nonprescription pain medicines, are treatments you buy yourself without a prescription at the pharmacy, for example:
All of these drugs - prescription or not - can have serious consequences if not used properly. Take as directed on the OTC Drug Facts label or Prescription Medication Guide and always follow your doctor's instructions.
Over 136 People Die Each Day from Narcotic Overdoses
Painkiller overdose deaths have become a national epidemic.
- And the numbers don't lie: 49,860 overdose deaths from opioids occurred in the US in 2019, the latest CDC statistics.
- In fact, synthetic opioids (other than methadone) are the main culprit involved in drug overdose deaths. Over 72% of opioid-involved overdose deaths involve synthetic opioids, such as drugs like oxycodone and hydrocodone.
- From 2018 to 2019, the largest increase in death rates involving synthetic opioids occurred in the Western part of the US (67.9%). Previously, the East had the highest increases in deaths involving synthetic opioids,
Education, treatment and prevention of addiction and overdose has become a national priority. Addiction treatment is an area where additional resources are needed.
If you are prescribed an opioid, always check the prescription label to learn how to use your medication safely.
What is buprenorphine?
Treatment for opioid use disorder and limits on prescribing, when possible, should be a main focus to help battle the opioid crisis.
Options for buprenorphine for opioid dependence include:
- a sublingual (under the tongue) pill: Zubsolv - also contains naloxone
- a film placed in the mouth: Suboxone - also contain naloxone
- an injection Sublocade - this option only contains buprenorphine.
- Probuphine Implant and Bunavail brands are now discontinued from the US market.
Note: there are also approved buprenorphine products ONLY used to treat severe pain, not opioid use disorder.
Brixadi (buprenorphine) subcutaneous extended release injection was granted tentative FDA approval for opioid use disorder in 2018. Upon final approval, it will provide a long-acting injectable buprenorphine alternative to Sublocade with both weekly and monthly dosing options.
Narcotic Overdoses Can Fatally Slow Your Breathing
If you believe someone has overdosed on narcotics, call 911 immediately to help prevent respiratory depression (severely slowed breathing) and possible death.
- All opioids painkillers will produce various levels of central nervous system (CNS) depression side effects such as drowsiness and sedation.
- But it does not take a large overdose to slow breathing, and this is especially true if a narcotic is combined with another central nervous system depressant such as alcohol or a benzodiazepine like alprazolam (Xanax).
- A reversal agent called naloxone (Narcan, Narcan Nasal Spray) may be life-saving for patients who overdose on narcotics.
- You should still call emergency services (911) immediately after you give a dose of naloxone to someone who has overdosed.
Naloxone can be kept by a caregiver or family member for administration in emergencies at home or away. Plus, naloxone can now be accessed at the pharmacy without a prescription in most states.
Many people are unaware of how to respond to an overdose, including how to use naloxone. Most forms of naloxone are very easy to use; they are made that way for quick administration. Just ask your pharmacist or physician for instructions if you feel unsure about it. Follow this link below to learn how to give naloxone.
Learn More: Know Your Naloxone: Save a Life
What Are Abuse-Deterrent Opioids?
Abuse-deterrent opioids are being developed in an effort to help lower rates of abuse, addiction and overdose.
Abuse-deterrent opioids include:
- Hysingla ER (hydrocodone extended-release)
- Oxycontin (oxycodone extended-release)
- Zohydro ER (hydrocodone extended-release)
These agents are specially formulated to make it more difficult to abuse the opioid if cut, crushed, chewed, or dissolved so as to inject or inhale ("snort") it for a greater "high".
Consuming these medications when manipulated in this way can release a large amounts of opioid at once which can cause overdose and death, usually due to severely slowed breathing (respiratory depression). However, these products are not 100% foolproof -- dangerous abuse can still occur.
Where Do Abusers Get Prescription Painkillers?
It’s a scary thought, but family members, including children, may obtain prescription drugs simply by taking them from the medicine cabinet. Expired medications may stay in cabinets for months or even years, yet still be potent.
In a National Survey on Drug Use and Health, those 12 years and older were asked how they obtained prescription drugs of abuse. Over 50 percent who used pain relievers said they got them 'from a friend or relative for free', or they stole them.
But there is good news. In the 2019 Monitoring the Future Survey, trends show the use of prescription opioids among 8th, 10th and 12th graders continues to decline from peaks in the years 2003 to 2009.
These statistics highlight the importance of keeping drugs away from family members who might abuse them, give them away, or even sell them. Continued drug abuse education among youth is critical.
Tramadol and Hydrocodone Are Now More Strictly Prescribed
As you may know, the number of refills on narcotic prescriptions are restricted. However, patients with ongoing, long-term pain may receive additional authorized refills if they need pain control around-the-clock. But doctors are cracking down on refills.
In 2014 many of the rules surrounding refills for prescription painkillers changed. On October 6, 2014, the Drug Enforcement Administration (DEA) finalized a rule that changed hydrocodone combination products like Lortab and Norco from schedule III to schedule II.
In addition, on August 18, 2014, tramadol (ConZip, Qdolo, Ultram) was placed into DEA schedule IV. Both of these changes place restrictions on the number and lengths of refills periods per prescription. These changes were instituted to help curb abuse and overdose.
Learn More: Tramadol: 9 Things You Should Know
Constipation: A Dangerous Side Effect of Opioids
With all the concern with abuse, it's hard to remember that, yes, these drugs have regular, often unpleasant side effects, too.
Opioid-induced constipation (OIC) is an unpleasant side effect of prescription opioid painkillers.
- Not only is it a nuisance, it can cause health problems such as hemorrhoids, anal fissures, rectal prolapse, or a rectal blockage.
- Since severe constipation can be dangerous, check with your doctor. They may want you to take a daily stool softener while you are on an opioid.
Opioids cause constipation by binding to intestinal receptors and slowing down your bowel movements. If you take an opioid for pain, and have less than three bowels movements per week -- with straining, hard stools, or incomplete bowel emptying -- you may need a short-term laxative or a prescription agent for opioid-induced constipation such as:
Experts Don’t Recommend Opioids For All Pain
Low back pain, headaches and fibromyalgia are common pain syndromes experienced by many patients.
However, guidelines issued by the U.S. Centers for Disease Control and Prevention (CDC) recommend that narcotics not be used as first-line agents for chronic pain. Most other medical expert groups agree.
Nonpharmacologic therapy (such as exercise) and nonopioid pharmacologic therapy (for example, ibuprofen or acetaminophen) are preferred for chronic pain. If opioids are used, they should be combined with nondrug therapy, like exercise, and nonopioid medications, as appropriate.
When opioids are needed for acute pain, clinicians recommend short use of the lowest effective dose. The length of treatment should be limited to 3 days or less; more than 7 days will rarely be needed. Doctors should initially prescribe immediate-release opioids instead of extended-release or long-acting (ER/LA) opioids like Oxycontin.
Regular monitoring and follow-up is needed. If your doctor finds the benefits of opioid treatment do not outweigh the harms of continued treatment, they may utilize other therapies and work with you to taper opioids to lower dosages or to taper and discontinue opioid painkillers.
Tylenol (acetaminophen) in Painkillers Can Be Dangerous, Too
Turning to OTC medications for pain treatment seems like an easy and safer alternative to opioid use. But there are warnings for these drugs, too. Just be aware.
Acetaminophen can be especially dangerous in an overdose situation. Overdoses from prescription drugs containing acetaminophen account for half of all U.S. cases of acetaminophen-related liver failure, and often end in a liver transplant or death
Check all OTC and prescription drug labels to see if they contain acetaminophen.
Do not exceed the recommended total daily dose (3,000 to 4,000 milligrams per day) of acetaminophen; closely follow the OTC label directions. If you drink alcohol frequently, your risk of liver damage will go up. Ask your pharmacist or doctor to check if your medicines contain acetaminophen if you are not sure.
Many non-opioid painkillers are acetaminophen-free; ask your doctor or pharmacist for a recommendation if you need to avoid acetaminophen.
OTCs: Ibuprofen, Naproxen or Acetaminophen Are Effective for Pain
Pain is often due to an inflammatory, swelling type of reaction, such as mild to moderate pain with a toothache, backache, joint or muscle pain.
NSAIDs like ibuprofen (Advil, Motrin) or naproxen (Aleve) are very effective at relieving pain due to inflammation. Headaches can also be effectively treated with either NSAIDs or acetaminophen (Tylenol).
However, NSAIDs can be hard on the stomach, elevate bleeding risk, and also have heart warnings. Bleeding risk can go up if you are on blood thinners, have a history of ulcers, or are older in age. Be sure to read the labels and check with your doctor first.
These medications are very affordable, but over-the-counter drugs can have side effects, too, especially if used at high doses. Review OTC labels and talk to your doctor about the proper dose and length of treatment for you or your child.
Drug-Free Treatment for Pain
However, narcotics require a prescription and many are now more restricted, making their access even more difficult, not to mention their risk of addiction potential.
When treating minor to moderate pain, also think holistically about how to treat pain:
are other drug-free methods that can help treat pain, or be an add-on to your current therapy. Ask your doctor for advice on drug-free treatment for pain.
Treatment programs also require other components besides medication to be most effective. Behavioral therapies such as cognitive-behavioral therapy, counseling sessions and group support can work to boost success with medical and drug treatments for addiction.
Learn More: Consider Joining the Drugs.com Opiate Dependence Support Group
Finished: Top Truths About Narcotic Painkiller Meds
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- National Institute on Drug Abuse. Monitoring the Future 2020 Survey Results. Infographics. Accessed March 29, 2021 at https://www.drugabuse.gov/drug-topics/related-topics/trends-statistics/infographics/monitoring-future-2020-survey-results
- Drug Overdose Deaths. U.S. Centers for Disease Control and Prevention (CDC). Accessed March 29, 2021 at https://www.cdc.gov/drugoverdose/data/statedeaths.html
- Monitoring the Future 1975–2018. National Survey Results On Drug Use. 2018 Overview. Key Findings on Adolescent Drug Use. Accessed March 16, 2020 at http://www.monitoringthefuture.org/pubs/monographs/mtf-overview2018.pdf
- The U.S. Center for Disease Control and Prevention (CDC). Quick reference for healthcare providers. Accessed March 29, 2021 at https://www.cdc.gov/drugoverdose/pdf/Guidelines_Factsheet-a.pdf
- Walgreens Stocking Life Saving Narcan Nasal Spray in All Pharmacies Nationwide. Accessed March 16, 2020.
- Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2016. Accessed March 16, 2020 at http://wonder.cdc.gov
- Understanding the Epidemic. CDC. Accessed March 29, 2021 at https://www.cdc.gov/drugoverdose/epidemic/index.html
- Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015. MMWR Morb Mortal Wkly Rep. Accessed March 16, 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm655051e1
- National Institute on Drug Abuse. The Science of Drug Abuse and Addiction. Frequently Asked Questions. Accessed March 16, 2020 at http://www.drugabuse.gov/frequently-asked-questions#quickly
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.