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Top 11 Truths About Narcotic Painkiller Meds

Medically reviewed on Apr 26, 2017 by L. Anderson, PharmD.

Over-the-Counter Painkillers or Narcotics: The Choices Are Numerous

Strong painkillers like opioids, also known as narcotics, require a prescription and have special DEA rules for dispensing by your pharmacist. Examples include drugs like Oxycontin (oxycodone) or Vicodin (hydrocodone).

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 - like Advil (ibuprofen), Aleve (naproxen), or Tylenol (acetaminophen). However, all of these drugs - prescription or not - can have serious consequences if not used properly and taken as directed on the OTC Drug Facts label or prescription label and by your doctor.

Over 40 People Die Each Day from Narcotics

Painkiller overdose deaths have become a national epidemic. The US Attorney General has stated that the growing number of deaths from prescription painkiller overdoses is an 'urgent and growing public health crisis'.

And the numbers don't lie: forty-five people die everyday from opioid (narcotic) prescription painkiller overdoses – more deaths than heroin and cocaine overdoses combined.

Treatment and prevention of addiction and overdose has become a national priority: in May 2016 the FDA approved the long-acting opioid partial agonist implant Probuphine. Probuphine is the first buprenorphine implant for the maintenance treatment of opiate dependence Probuphine consists of four, one-inch-long rods that are placed in the upper arm and provide a low dose of buprenorphine for six months.

Narcotic Overdoses Can Fatally Slow Your Breathing

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, Evzio) may be life-saving for patients who overdose on narcotics. If you believe someone has overdosed on narcotics, call 911 immediately to help prevent fatal respiratory depression. If okayed by your doctor, Narcan Nasal Spray or Evzio can be kept for administration by a caregiver in emergencies at home or away.

Many Who Suffer an Overdose Don’t Know What to Do

A study published in 2014 surveyed a group of users aged 18 to 32 in New York City. Most of those surveyed were white and had some college education, and had either overdosed themselves or knew someone who had.

However, the majority were unaware of how to respond to an overdose, including how to use naloxone; there was a common belief that naloxone was hard to get and expensive. In fact, in New York City naloxone is free with training in many recovery programs. Researchers stated that outreach programs and training are needed for abuse recovery and response.

Newer abuse-deterrent opioids like Hysingla ER (hydrocodone), Embeda (morphine/naltrexone), reformulated Oxycontin, Targiniq ER (oxycodone/naltrexone), and Zohydro ER (hydrocodone), Troxyca ER (oxycodone/naltrexone), Arymo ER (morphine sulfate extended-release tablet), and Vantrela ER (hydrocodone bitartrate) are being developed in an effort to help lower rates of abuse and overdose.

Where Do Abusers Get Prescription Painkillers?

It’s a scary thought, but family members may obtain prescription drugs to abuse 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. These statistics highlight the importance of keeping drugs away from family members who might abuse them, give them away, or even sell them. Consider an appropriate method to dispose of unused prescription drugs.

Tramadol and Hydrocodone Are Now More Strictly Prescribed

As you know, the number of refills on narcotic prescriptions are restricted. However, patients with chronic, long-term pain may receive additional authorized refills if they need pain control around-the-clock. In 2014 many of the rules surrounding refills for prescription painkillers changed. On October 6, 2014, the final Drug Enforcement Administration (DEA) rule on changing hydrocodone combination products like Lortab and Vicodin from schedule III to schedule II took effect. In addition, on August 18, 2014, tramadol was placed into DEA schedule IV. These changes were instituted to help curb abuse.

Constipation Can Be a Dangerous Side Effect of Opioids

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. 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 Amitiza (lubiprostone), Movantik (naloxegol), Relistor (methylnaltrexone), or Symproic (naldemedine). Since severe constipation can be dangerous, check with your doctor.

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 American Academy of Neurology (AAN) recommend that narcotics such as morphine, codeine, oxycodone, methadone, fentanyl, hydrocodone, or hydrocodone combinations should be avoided in patients with these long-term pain syndromes. The AAN states that opioid risks such as addiction, overdose, and death far outweigh their benefits. In fact, the AAN recommends that doctors work alongside pain management specialists if opioid doses exceed certain levels.

Acetaminophen in Combo Painkillers Can Be Dangerous

Pain medications like Lortab and Vicodin, also contain acetaminophen. You may not know that 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 drugs for acetaminophen. Do not exceed the recommended total daily dose (3,000 to 4,000 milligrams per day) of acetaminophen; closely follow OTC label directions. Many painkillers are acetaminophen-free; ask your doctor or pharmacist for a recommendation.

OTCs: Ibuprofen, Naproxen or Acetaminophen Are Effective for Pain

Pain is often due to an inflammatory reaction, especially short-term, mild to moderate pain like a toothache, backache, joint or muscle pain. NSAIDs are very effective at relieving pain due to inflammation. Headaches can be effectively treated with either NSAIDs or acetaminophen (Tylenol). Another bonus: these medications are very cost effective. However, over-the-counter drugs can have side effects, too, especially if used at high doses. Talk to your doctor about the proper dose for you or your child.

Think of Other Options to Help with Pain Relief

Many pain medications like NSAIDs and acetaminophen are available in generic and over-the-counter formulations without a prescription, which can save you bucks. However, narcotics require a prescription and many are now prescribed under schedule II, making their access even more difficult, not to mention their addiction potential. When treating minor to moderate pain, also think holistically about how to treat pain: yoga, meditation, exercise and acupuncture are other drug-free methods that may help to treat pain, or at least be an add-on to your current therapy. Ask your doctor for advice on drug-free treatment for pain.

Finished: Top 11 Truths About Narcotic Painkiller Meds

Know Your Naloxone: Save a Life

In many states, the opioid-reversal agent naloxone (Narcan Nasal, Evzio) can be stored in the homes of those at risk for narcotic overdose. Some states allow access directly from the…



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  • The United States Department of Justice. Office of Public Affairs. Attorney General Holder, Calling Rise in Heroin Overdoses ‘Urgent Public Health Crisis,’ Vows Mix of Enforcement, Treatment. Accessed 2/10/2017 at