Opioids originated from poppy seeds, the natural source of opium. Many years later, many different forms of this type of medication exist. Some are made from the original source, poppies. Others are made in labs, and are known as synthetic or semi-synthetic. You may be familiar with some of the opioid medications listed in the sidebar.
In spite of having different chemical natures, all opioids work in the same way. They differ only in terms of strength, length of action, dosage form (patch, tablet, or injection) and how quickly they provide analgesia (pain relief).
It is often best to manage chronic pain with long-lasting opioids that only need to be taken a few times a day. The goal is to prevent extreme pain, rather than chasing after it with short-acting medications.
While people may respond better to one form of opioid than another, the reaction is difficult to predict. For instance, a certain enzyme in the body converts the drug codeine to an active form. It is thought that in up to half of people in North America, the enzyme works poorly or is inactive. If these people take codeine, they will receive little or no pain relief.
At the same time, about one to five per cent of people have what are basically super enzymes. For some reason, they convert codeine to its active form very quickly and efficiently. They can suffer from concerning side effects at very low doses.
Scientists are just learning about these very individual differences. In time, we may be better able to predict which drugs will work for which people. For now, health care providers can only make an informed guess.
Opioids work by binding to opioid receptors in the body. The receptors are located throughout the body and brain as part of the nervous system and the gut. Both the benefits of the opioid and its negative effects depend on how it binds to the receptors, where, and for how long.
Opioids are terrific at treating certain types of pain, especially musculoskeletal (MSK or muscle and joint) pain. This pain is associated with joint and muscle injury or breakdown. It is often described as aching, throbbing, or stiffness. Most people with this type of pain achieve some relief from these medications.
Other types of pain do not respond as reliably to opioid medication. This includes headaches and the nerve pain associated with diabetec neuropathy, sciatica and some aspects of fibromyalgia. Such pain is often described as burning, shooting, pins and needles, or numbness. In fact, this type of pain may not respond to opioids at all.
Like any medication, opioids can cause side effects. Some are predictable. They may or may not lessen over time. Some common side effects tend to go away with continued use. This includes nausea, drowsiness, dry mouth, and sweating. Other side effects, such as constipation, happen to almost everyone taking opioids. These do not go away over time. Almost all people taking opioids, even for a short time, must pay attention to their bowels. They will need to use various means to ensure they are regular. This may mean drinking more water, eating differently or using medication.
Opioids can cause dependence (sometimes incorrectly referred to as addiction). People may also use them for the euphoric (up or happy) feeling that can result from their use.
There is a difference between dependence and addiction. It is true that as narcotics or opioids are used, the body can become dependent on them. This basically means someone who suddenly stops taking this medication might feel signs of withdrawal. Signs include shaking, flushing, irritability, diarrhea, and runny nose. This is natural and expected. The opioid receptors in the body are used to having the medication there. Once it is removed, the body needs an adjustment period to get used to not having the drug anymore.
This happens with all kinds of substances. Let's say you love coffee and drink three, four, five, or more cups of caffeinated coffee each day. If you suddenly stop drinking it, you will almost surely notice that you are more tired and irritable. You might also have a headache. Your body is adjusting to the fact that the caffeine normally taking up receptors is not there. This 'withdrawal' can be anticipated. It is easier if you taper off (slowly remove) the substance. Generally it does not result in any long-term damage to the body.
Addiction, on the other hand, involves using an opioid for reasons other than pain relief. Some people get a good feeling or euphoria from it. Taking a medication to experience that feeling, even if it does your body or life harm, is addiction. Since opioids can cause this type of behaviour in a small number of people, they are highly regulated. Only a doctor or dentist can write a prescription for an opioid. In some provinces, there may be a special prescription process used to monitor the use of these drugs.
Thankfully, addiction is rare for people who are prescribed opioids to manage pain who have no history of drug abuse. Those at higher risk of developing addiction generally can be identified. They can be treated safely with opioids using extra monitoring and prescribing precautions. Such a person might be asked to sign a contract saying they will only receive opioids from one doctor. Random urine screening will also be part of the agreement. This is important, as it helps the doctor identify all medications being taken. This supportive information can be used to provide a drug screen or when applying for a job.
Finally, tolerance can also occur with these medications. A medication relieves pain, but over time it may seem to work less and less. It could be that the pain is increasing, as when someone with Crohn's disease has a flare-up. The body may also adjust to that level of medication and need more to achieve the same effect. If this tolerance becomes significant, and increasing doses of medication are a concern, people are sometimes taken off opioids. They may find that pain is better without the drug than with it.
Communication ensures the best use of opioids. Write down what is happening and how it relates to the opioid. Be completely honest and open with this information. Unless you tell your health care providers what is happening, it is difficult to fix any concerns or answer questions. Reviewing information collected over a few days or weeks allows a doctor, pharmacist or other heath care professional to assess if you are getting the best pain relief possible with the least side effects. This is different for every person and situation.
Keep in mind that opioids are just one of dozens of tools that change how the body perceives pain and how each person chooses to function with that level of pain. Remember too that it is not realistic to expect any treatment to relieve chronic pain completely. Lowering pain by 30 per cent is considered success. Most people can do more and enjoy life a lot more with a pain level of 5/10 compared to 8/10.
Opioids can be a very helpful part of a treatment plan for some people with chronic pain. However, they cannot treat every type of pain. As well, their use must be planned specifically for each person and situation. Use them along with other medications and many different types of therapies to improve your quality of life.