Dispensing Knowledge

EDITOR’S NOTE: This two-part article is meant to provide a little more information on opioids and harm reduction strategies, specifically the rescue medication, naloxone (Narcan®).

Part 1

There’s lots of talk about opioids in the news, so let’s talk about them. A 2017 report by Health Quality Ontario found that about one out of every seven people in Ontario (9 million individuals) filled an opioid prescription in 2015/2016. More individuals are being hospitalized due to opioid poisoning, and more individuals are dying due to opioid overdoses than from motor vehicle collisions.

What are opioids? Opioids are prescription medications that are usually used for both acute and chronic pain. Other reasons that they may be prescribed by your physician or nurse practitioner is to manage persistent cough or diarrhea. Treatment of opioid use disorder is another medical use for prescription opioids, specifically methadone or buprenorphine-naloxone (Suboxone®). Opioids are commonly referred to as “pain killers” or “narcotics” and include: buprenorphine, codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine or oxycodone.

Opioids can be effective in reducing pain and improving function, but there are also risks. Short-term side effects can include: drowsiness, constipation, nausea/vomiting, dizziness, confusion, difficulty breathing, and feelings of euphoria. Long-term and more serious side effects and risks include: increased tolerance, substance use disorder or dependence, worsening pain (known as “opioid-induced hyperalgesia”), and overdose. With long-term use of opioids our body develop tolerance: requiring higher and higher doses over time to achieve the same effect. Our bodies can also become dependent on opioids: if opioids are stopped abruptly, we will see signs and symptoms of opioid withdrawal.

Opioids have the potential for misuse because they can cause feelings of euphoria or the sensation of being “high”. We tend to think of opioid misuse that involves using illicit opioids such as heroin or fentanyl, but misuse also happens with prescription opioids, such as taking more than prescribed, taking it at the wrong time, or using a prescription opioid that was not prescribed for you.

If you have any questions or concerns regarding anything discussed in this article, please reach out to any member of your healthcare team. Next week we will talk about harm reduction and the overdose rescue medication, Naloxone.