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Top Truths About Narcotic Painkiller Meds

Medically reviewed by L. Anderson, PharmD. Last updated on Mar 22, 2018.

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

Opioids are in the news daily and the statistics -- overdoses, emergency room admissions, and deaths -- are shocking. It's important to understand opioids.

Strong painkillers like opioids, also known as narcotics, require a prescription and have special DEA rules for dispensing by your pharmacist.

Opioid examples include drugs 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:

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 as directed by your doctor.

Over 115 People Die Each Day from Narcotic Overdoses

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'. The U.S. government is urgently trying to address the opioid crisis and allocating massive funds -- in fact $3.6 billion in the 2018 national budget -- to tackle it.

And the numbers don't lie: over 115 people die everyday from opioid (narcotic) overdoses. In fact, death from prescription opioids, drugs like oxycodone, hydrocodone, and methadone, have increased fourfold since 1999, as noted by the CDC.

Education, treatment and prevention of addiction and overdose has become a national priority. Addiction treatment is an area where additional resources are needed.

What is Probuphine?

As one treatment response to the opioid crisis, in 2016 the FDA approved the long-acting opioid partial agonist implant Probuphine (buprenorphine).

Probuphine is the first buprenorphine implant for the maintenance treatment of opiate dependence. Prior to this, buprenorphine for opioid dependence was only avaialble as a pill or a film placed in the mouth.

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. It's designed to provide a constant, low-level dose of buprenorphine in patients who are already stable on low-to-moderate doses of other forms of buprenorphine.

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

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, Evzio) may be life-saving for patients who overdose on narcotics.

Naloxone (Narcan Nasal Spray, Evzio) or other naloxone agents can be kept for administration by a caregiver in emergencies at home or away. As of October 2017, naloxone can be accessed at the pharmacy without a prescription in 45 states, according to U.S.-based Walgreens Pharmacies. 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 for instructions if you feel unsure about it.

Learn More: Know Your Naloxone: Save a Life

What Are Abuse-Deterrent Opioids?

Newer abuse-deterrent opioids include:

Abuse-deterrent opioids are being developed in an effort to help lower rates of abuse, addiction and overdose.

These agents are specially formulated to make it more difficult to abuse the opioid if cut, crushed, chewed, dissolved, or otherwise manipulated to inject or inhale ("snort") it for a greater "high". Consuming the medication 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 -- abuse by the intranasal, oral, and injectable routes are still possible with these products, even as noted in their package inserts.

Where Do Abusers Get Prescription Painkillers?

It’s a scary thought, but family members, including children, 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 this 2017 update from the FDA on appropriate methods to dispose of unused prescription drugs.

However, there is some good news: the 2017 Monitoring the Future Survey results showed that misuse of Vicodin in the year before the survey had dropped dramatically among 12th graders over the last 15 years. In fact, misuse of all prescription opioids for 12th graders dropped dramatically, even though misuse among adults soared.

Learn More: How to Safely Dispose of Your Old Medications

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 Drug Enforcement Administration (DEA) finalized a rule that changed hydrocodone combination products like Lortab and Vicodin from schedule III to schedule II.

In addition, on August 18, 2014, tramadol 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.

Learn More: Tramadol: 9 Things You Should Know

Constipation: 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. 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. Many 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/long-acting (ER/LA) opioids.

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

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 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.

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 reaction, especially short-term, mild to moderate pain like a toothache, backache, joint or muscle pain. NSAIDs such as ibuprofen (Advil, Motrin) or naproxen (Aleve) are very effective at relieving pain due to inflammation. However, they can be hard on the stomach, elevate bleeding risk, and have heart warnings. Be sure to read the labels.

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 and length of treatment for you or your child.

Drug-Free Treatment for Pain

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 more restricted, 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:

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.

Finished: Top Truths About Narcotic Painkiller Meds

Know Your Naloxone: Save a Life

How do you recognize an overdose when it occurs? The opioid-reversal agent naloxone (Narcan Nasal, Evzio) can be stored at home and carried by those at risk of narcotic overdose,…

Sources

  • The U.S. Center for Disease Control and Prevention (CDC). Guideline for Prescribing Opioids for Chronic Pain. 2016. Infographic. Accessed March 21, 2018 at https://www.cdc.gov/drugoverdose/pdf/Guidelines_Factsheet-a.pdf
  • Walgreens Stocking Life Saving Narcan Nasal Spray in All Pharmacies Nationwide. Accessed March 21, 2018 at http://news.walgreens.com/press-releases/general-news/walgreens-stocking-life-saving-narcan-nasal-spray-in-all-pharmacies-nationwide.htm
  • Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2016. Accessed March 22, 2018 at http://wonder.cdc.gov
  • Drug overdose deaths in the United States continue to increase in 2016. U.S. Centers for Disease Control and Prevention (CDC). Opioid Overdose. Understanding the Epidemic. Accessed March 21, 2018 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. ePub: 16 December 2016. Accessed March 22, 2018. DOI: http://dx.doi.org/10.15585/mmwr.mm655051e1
  • National Institute on Drug Abuse. The Science of Drug Abuse and Addiction. Infographics. Accessed March 22, 2018 at http://www.drugabuse.gov/related-topics/trends-statistics/infographics
  • National Institute on Drug Abuse. The Science of Drug Abuse and Addiction. Frequently Asked Questions. 3/2017. Accessed March 22, 2018 at http://www.drugabuse.gov/frequently-asked-questions#quickly
  • 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 March 22, 2018 at http://www.justice.gov/opa/pr/2014/March/14-ag-246.html

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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