Wednesday, April 10, 2019
Wednesday, April 3, 2019
OD,Opioids Overdose Number 1 Killer of Americans in the United States,How not to become a victim
OD,Opioids Overdose Number 1 Killer of Americans in the United States,How not to become a victim, a patient and non patient information guide.
Prescription Opioid Medicines Include:
• Hydrocodone (Vicodin®, Lortab®, Norco®)
• Oxycodone (OxyContin®, Percocet®, Endocet®,)
• Morphine (MS Contin®, Kadian®, Oramorph SR®)
• Hydromorphone (Dilaudid®)
• Fentanyl (Duragesic®)
• Codeine (Tylenol® with Codeine #3, Tylenol® with
Codeine #4)
• Methadone (Dolophine HCL®, MethadoseTM)
• Tramadol (Ultram®)
• Buprenorphine (Butrans®)
• Oxymorphone (Opana®)
• Tapentadol (Nucynta®
These are the opioids that are available in the market in the United States of America.(50 states)
Opioids also can come from sources other than medicines you get from your healthcare providers. These
include medicines not prescribed to you (e.g., from family or friends) and “street drugs.” Any medicine that
you did not get from a pharmacy with a prescription can have extra risks. The ingredients and strength may
not be known, for example, counterfeit pills may contain fentanyl or carfentanil (“elephant tranquilizers”). It is
important for you to inform your provider(s) about all medicines and substances you are taking as some can
interact to cause harm, including overdose and death.
Your healthcare team will talk to you about the best ways to treat your pain. Together, you will discuss the
goals for your treatment and how much relief you can expect from the different options. An example of a
goal would be to improve your ability to move, exercise, and participate in activities you enjoy.
Opioids are not the most effective treatment for long-term, non-cancer pain. In fact, opioids are no longer
recommended for the treatment of most patients with chronic pain. If prescription opioids are used, you will
be given information on possible side effects, other risks, and monitoring needed for your safety.
Over the past 20 years, we have learned several important things about using opioids for chronic pain.
1. Tolerance
When opioids are taken daily, your body gets used to the medication. Over time, the opioid will be less
effective at lowering your pain. Needing higher and higher doses to achieve the desired effect is a sign that
you may be at risk for addiction and overdose and should alert you and your team to reassess your pain
treatment plan.
2. Risks
Opioids come with serious risks that are outlined on pages 4 and 5. The most serious risks include
respiratory depression (stopping breathing - also known as “overdose”) resulting in death, and the risk of
developing opioid use disorder (from moderate to severe is also known as “addiction”). Increasing the dose
of an opioid will increase the risk of opioid use disorder, overdose, and other side effects.
3. Risk increases with other health conditions, medicines, and substances
If you have health conditions such as sleep apnea, breathing problems, liver problems, or kidney problems,
you may have a higher risk for overdose and side effects even with low doses of opioids. Drinking alcohol,
using benzodiazepines, or taking other medicines that can make you sleepy can increase your risk of side
effects and overdose. These substances are not recommended in combination with an opioid medicine.
4. Dependence
Dependence means that your body will depend on the opioid to feel normal. If you stop the opioid
suddenly or decrease the dose too quickly, you will feel increased pain and other symptoms of opioid
withdrawal. This may make it hard to stop even if you want to. Dependence can happen even when low
doses of opioids are taken for acute pain, such as dental procedures or fractures, for less than one week.
Opioids may be needed for acute pain in some situations. To reduce the risk of dependence when treating
acute pain, opioids should be used for five days or less.
5. Opioid Use Disorder
Opioid use disorder is a chronic brain disease that develops from repeated use of opioids. In its moderate
to severe form, it is also known as addiction and can be life-threatening. The risk of death from overdose is
6 to 20 times greater for those with opioid use disorder than for the general population. Symptoms include
preoccupation with and craving for opioids, continued use despite significant opioid-related problems,
often using more opioids than intended, and other signs that one has lost the ability to control the use of
opioids. While not every patient who develops tolerance and dependence has an opioid use disorder, these
are two signs of increased risk of opioid use disorder. When carefully assessed, 25% to 40% of patients on
long-term opioid therapy (more than 90 days) has an opioid use disorder.
Your Pain Care Plan
Even if opioids are used to reduce pain, they will be most
effective when combined with other safer and more effective
strategies. You and your healthcare team will make a pain care
plan based on your condition and specific situation. Treatments
may include self-care activities, non-medication treatments or
therapies, medicines that do not contain opioids and, in some
instances, opioid-containing medicines. Here is a list of some
commonly used options that might be included in your pain
care plan.
1. Self-care
These activities include everything you can do on your own
to manage your health (including pain) and live your life as
fully as possible.
• General Health Activities
o Develop or maintain supportive relationships.
o Get a good night’s sleep every night.
o Eat healthy foods including fruits and vegetables.
o Move your body every day and do activities you enjoy.
o Stop smoking and using other tobacco products.
o Try meditation or other relaxing activities.
• Pain Management Strategies
o Improve your posture: stand or sit up straight.
o If you are overweight, lose weight. Consider enrolling in a weight management program.
o Practice yoga, exercise, stretching, and/or Tai Chi.
o Learn and practice deep breathing and relaxation exercises.
o Use heat or cold packs on the painful areas.
o Attend pain management classes and join support groups.
2. Non-medication Treatments
• Behavioral Therapies
o Learn to react to pain in a way that helps you function better
and reduce your pain, for example, Cognitive Behavioral
Therapy (CBT), Acceptance and Commitment Therapy (ACT),
and/or mindfulness-based therapies including meditation.
• Acupuncture
• Spinal Manipulation (Chiropractic therapy)
• Physical Therapy and Occupational Therapy
• Nerve stimulation (like a Transcutaneous Electrical Nerve
Stimulator [TENS unit])
3. Non-opioid Medication Treatments
• Topical Treatments
o Gels, creams, ointments, or patches that are applied to the skin on a painful area, for example,
diclofenac gel, methyl salicylate cream/ointment, lidocaine patch or ointment
• Oral Treatments
o Anti-inflammatory medicines – for muscle/bone pain
- Nonsteroidal anti-inflammatory drugs (NSAIDs), for example, ibuprofen, naproxen, meloxicam,
etodolac, celecoxib
o Antidepressant medicines – for muscle/bone and nerve pain
- Tricyclic antidepressants (TCA), for example, nortriptyline, desipramine, amitriptyline, imipramine
- Serotonin norepinephrine reuptake inhibitors (SNRI), for example, duloxetine, venlafaxine
o Anticonvulsant medicines – for nerve pain, for example, gabapentin, pregabalin
4. Opioid Medicines
• Opioids are more effective in reducing acute pain than chronic pain
o Usually only “take the edge off” chronic pain for a short time.
o Daily use of opioids can actually make your pain worse over time.
• No matter how much you take, opioids will not take the pain away.
o Any dose can be risky, even a small dose.
o Higher doses usually cause more side effects, without reducing your pain.
• All opioids can cause respiratory depression (slow or shallow breathing) and overdose death.
• Methadone is an opioid that is sometimes used for chronic pain. Because it is so long-acting, the amount
can build up, putting you at risk for overdose.
o Methadone can cause changes in your heart beat that you may not notice. Your heart beat should be
monitored by electrocardiogram (EKG) testing.
o Many medicines interact with methadone and, in some cases, cause harm, including overdose
and death.
5. Other Treatment Options
• You may benefit from more specialized treatments available in
some primary care clinics or from some pain clinics.
o These treatments may include trigger point injections in areas
of localized pain and muscle spasms, or steroid injections for
joint pain.
• Pain clinics may provide epidural steroid injections and several
types of pain blocks that can help some patients with spine
conditions. Rarely, spinal cord stimulation devices or spine
surgery may be considered.
o These interventional pain procedures are for pain conditions
that have not or are not likely to respond to other treatments.
It is important to report any side effects to your healthcare team. Tell your healthcare team if side effects
interfere with your daily activities. This information will help them to better manage your pain.
What Can You Do to Reduce Your Risk When Taking Opioids?
A good plan starts with a conversation. Your healthcare team will
talk with you about the risks, possible benefits, and any alternatives
to using opioids to manage chronic pain. This will be done before
any opioids are prescribed. After answering your questions, you will
be asked to sign an informed consent form.
Signing this form shows that you understand and agree with your
treatment plan that includes opioids and the possible risks when
taking them for chronic pain. You will learn about ways to reduce
risks and increase the chance that your plan will help you manage
your pain.
ü Take all your medicines
as prescribed.
Taking more opioid pain medicine than you need puts you at risk for side
effects and possible overdose and death. Talk with your healthcare team
before making any changes involving your medications.
ü Talk to your healthcare
team if you are having
more pain.
Do not take extra doses of opioid medication. You may run out of pills
early and this can cause withdrawal symptoms. Taking extra doses can also
increase your risk of overdose and death.
ü Recognize side effects. If you are having side effects that you cannot tolerate, take a lower dose or
stop the medication, and call your healthcare team.
ü Let all your providers
in the VA and outside
of the VA know you are
taking opioids.
Tell all your providers, including dentists, surgeons and specialists, that you
are taking opioids. Taking opioids from multiple providers may lead you to
use more than needed which can cause an overdose.
ü Tell your VA providers
about all medicines
and supplements you
are taking.
Tell them about over-the-counter medicines, herbal supplements, and if
you take medicines or substances that are not prescribed to you. Many
medicines and substances can interact. When your provider knows
about what you are taking, they are better equipped to make the most
appropriate pain plan for you. This will put you at a lower risk for side effects.
ü Do not take medicines
prescribed for someone
else. Do not give away or
sell your medicines.
Taking medicines that are prescribed to someone else, including a family
member, is illegal and can put you at risk for harmful side effects and
possible overdose and death. Keep your medicines in a safe and secure
location. If someone steals your opioids or your opioid prescription,
promptly report the theft to the police. Then, speak to your healthcare team
about your options because early refills may or may not be approved.
ü Avoid alcohol and
street drugs.
Combining opioids with alcohol, marijuana, or using “street drugs” can cause
severe harm or death. It is important that your provider know about all
substances you are taking. Your provider cannot safely continue prescribing
opioids if using these substances creates a safety concern.
ü Be informed about
the risk of developing
opioid dependence.
Anyone taking opioids can develop dependence. The risk goes up the
longer you take opioids and with higher doses. Treatments are available
for opioid dependence. Talk to your healthcare team if you feel this may be
happening to you\
Compiled by Jr Patatas
Facebook of Jr Patatas
Prescription Opioid Medicines Include:
• Hydrocodone (Vicodin®, Lortab®, Norco®)
• Oxycodone (OxyContin®, Percocet®, Endocet®,)
• Morphine (MS Contin®, Kadian®, Oramorph SR®)
• Hydromorphone (Dilaudid®)
• Fentanyl (Duragesic®)
• Codeine (Tylenol® with Codeine #3, Tylenol® with
Codeine #4)
• Methadone (Dolophine HCL®, MethadoseTM)
• Tramadol (Ultram®)
• Buprenorphine (Butrans®)
• Oxymorphone (Opana®)
• Tapentadol (Nucynta®
These are the opioids that are available in the market in the United States of America.(50 states)
Opioids also can come from sources other than medicines you get from your healthcare providers. These
include medicines not prescribed to you (e.g., from family or friends) and “street drugs.” Any medicine that
you did not get from a pharmacy with a prescription can have extra risks. The ingredients and strength may
not be known, for example, counterfeit pills may contain fentanyl or carfentanil (“elephant tranquilizers”). It is
important for you to inform your provider(s) about all medicines and substances you are taking as some can
interact to cause harm, including overdose and death.
Your healthcare team will talk to you about the best ways to treat your pain. Together, you will discuss the
goals for your treatment and how much relief you can expect from the different options. An example of a
goal would be to improve your ability to move, exercise, and participate in activities you enjoy.
Opioids are not the most effective treatment for long-term, non-cancer pain. In fact, opioids are no longer
recommended for the treatment of most patients with chronic pain. If prescription opioids are used, you will
be given information on possible side effects, other risks, and monitoring needed for your safety.
Over the past 20 years, we have learned several important things about using opioids for chronic pain.
1. Tolerance
When opioids are taken daily, your body gets used to the medication. Over time, the opioid will be less
effective at lowering your pain. Needing higher and higher doses to achieve the desired effect is a sign that
you may be at risk for addiction and overdose and should alert you and your team to reassess your pain
treatment plan.
2. Risks
Opioids come with serious risks that are outlined on pages 4 and 5. The most serious risks include
respiratory depression (stopping breathing - also known as “overdose”) resulting in death, and the risk of
developing opioid use disorder (from moderate to severe is also known as “addiction”). Increasing the dose
of an opioid will increase the risk of opioid use disorder, overdose, and other side effects.
3. Risk increases with other health conditions, medicines, and substances
If you have health conditions such as sleep apnea, breathing problems, liver problems, or kidney problems,
you may have a higher risk for overdose and side effects even with low doses of opioids. Drinking alcohol,
using benzodiazepines, or taking other medicines that can make you sleepy can increase your risk of side
effects and overdose. These substances are not recommended in combination with an opioid medicine.
4. Dependence
Dependence means that your body will depend on the opioid to feel normal. If you stop the opioid
suddenly or decrease the dose too quickly, you will feel increased pain and other symptoms of opioid
withdrawal. This may make it hard to stop even if you want to. Dependence can happen even when low
doses of opioids are taken for acute pain, such as dental procedures or fractures, for less than one week.
Opioids may be needed for acute pain in some situations. To reduce the risk of dependence when treating
acute pain, opioids should be used for five days or less.
5. Opioid Use Disorder
Opioid use disorder is a chronic brain disease that develops from repeated use of opioids. In its moderate
to severe form, it is also known as addiction and can be life-threatening. The risk of death from overdose is
6 to 20 times greater for those with opioid use disorder than for the general population. Symptoms include
preoccupation with and craving for opioids, continued use despite significant opioid-related problems,
often using more opioids than intended, and other signs that one has lost the ability to control the use of
opioids. While not every patient who develops tolerance and dependence has an opioid use disorder, these
are two signs of increased risk of opioid use disorder. When carefully assessed, 25% to 40% of patients on
long-term opioid therapy (more than 90 days) has an opioid use disorder.
Your Pain Care Plan
Even if opioids are used to reduce pain, they will be most
effective when combined with other safer and more effective
strategies. You and your healthcare team will make a pain care
plan based on your condition and specific situation. Treatments
may include self-care activities, non-medication treatments or
therapies, medicines that do not contain opioids and, in some
instances, opioid-containing medicines. Here is a list of some
commonly used options that might be included in your pain
care plan.
1. Self-care
These activities include everything you can do on your own
to manage your health (including pain) and live your life as
fully as possible.
• General Health Activities
o Develop or maintain supportive relationships.
o Get a good night’s sleep every night.
o Eat healthy foods including fruits and vegetables.
o Move your body every day and do activities you enjoy.
o Stop smoking and using other tobacco products.
o Try meditation or other relaxing activities.
• Pain Management Strategies
o Improve your posture: stand or sit up straight.
o If you are overweight, lose weight. Consider enrolling in a weight management program.
o Practice yoga, exercise, stretching, and/or Tai Chi.
o Learn and practice deep breathing and relaxation exercises.
o Use heat or cold packs on the painful areas.
o Attend pain management classes and join support groups.
2. Non-medication Treatments
• Behavioral Therapies
o Learn to react to pain in a way that helps you function better
and reduce your pain, for example, Cognitive Behavioral
Therapy (CBT), Acceptance and Commitment Therapy (ACT),
and/or mindfulness-based therapies including meditation.
• Acupuncture
• Spinal Manipulation (Chiropractic therapy)
• Physical Therapy and Occupational Therapy
• Nerve stimulation (like a Transcutaneous Electrical Nerve
Stimulator [TENS unit])
3. Non-opioid Medication Treatments
• Topical Treatments
o Gels, creams, ointments, or patches that are applied to the skin on a painful area, for example,
diclofenac gel, methyl salicylate cream/ointment, lidocaine patch or ointment
• Oral Treatments
o Anti-inflammatory medicines – for muscle/bone pain
- Nonsteroidal anti-inflammatory drugs (NSAIDs), for example, ibuprofen, naproxen, meloxicam,
etodolac, celecoxib
o Antidepressant medicines – for muscle/bone and nerve pain
- Tricyclic antidepressants (TCA), for example, nortriptyline, desipramine, amitriptyline, imipramine
- Serotonin norepinephrine reuptake inhibitors (SNRI), for example, duloxetine, venlafaxine
o Anticonvulsant medicines – for nerve pain, for example, gabapentin, pregabalin
4. Opioid Medicines
• Opioids are more effective in reducing acute pain than chronic pain
o Usually only “take the edge off” chronic pain for a short time.
o Daily use of opioids can actually make your pain worse over time.
• No matter how much you take, opioids will not take the pain away.
o Any dose can be risky, even a small dose.
o Higher doses usually cause more side effects, without reducing your pain.
• All opioids can cause respiratory depression (slow or shallow breathing) and overdose death.
• Methadone is an opioid that is sometimes used for chronic pain. Because it is so long-acting, the amount
can build up, putting you at risk for overdose.
o Methadone can cause changes in your heart beat that you may not notice. Your heart beat should be
monitored by electrocardiogram (EKG) testing.
o Many medicines interact with methadone and, in some cases, cause harm, including overdose
and death.
5. Other Treatment Options
• You may benefit from more specialized treatments available in
some primary care clinics or from some pain clinics.
o These treatments may include trigger point injections in areas
of localized pain and muscle spasms, or steroid injections for
joint pain.
• Pain clinics may provide epidural steroid injections and several
types of pain blocks that can help some patients with spine
conditions. Rarely, spinal cord stimulation devices or spine
surgery may be considered.
o These interventional pain procedures are for pain conditions
that have not or are not likely to respond to other treatments.
It is important to report any side effects to your healthcare team. Tell your healthcare team if side effects
interfere with your daily activities. This information will help them to better manage your pain.
What Can You Do to Reduce Your Risk When Taking Opioids?
A good plan starts with a conversation. Your healthcare team will
talk with you about the risks, possible benefits, and any alternatives
to using opioids to manage chronic pain. This will be done before
any opioids are prescribed. After answering your questions, you will
be asked to sign an informed consent form.
Signing this form shows that you understand and agree with your
treatment plan that includes opioids and the possible risks when
taking them for chronic pain. You will learn about ways to reduce
risks and increase the chance that your plan will help you manage
your pain.
ü Take all your medicines
as prescribed.
Taking more opioid pain medicine than you need puts you at risk for side
effects and possible overdose and death. Talk with your healthcare team
before making any changes involving your medications.
ü Talk to your healthcare
team if you are having
more pain.
Do not take extra doses of opioid medication. You may run out of pills
early and this can cause withdrawal symptoms. Taking extra doses can also
increase your risk of overdose and death.
ü Recognize side effects. If you are having side effects that you cannot tolerate, take a lower dose or
stop the medication, and call your healthcare team.
ü Let all your providers
in the VA and outside
of the VA know you are
taking opioids.
Tell all your providers, including dentists, surgeons and specialists, that you
are taking opioids. Taking opioids from multiple providers may lead you to
use more than needed which can cause an overdose.
ü Tell your VA providers
about all medicines
and supplements you
are taking.
Tell them about over-the-counter medicines, herbal supplements, and if
you take medicines or substances that are not prescribed to you. Many
medicines and substances can interact. When your provider knows
about what you are taking, they are better equipped to make the most
appropriate pain plan for you. This will put you at a lower risk for side effects.
ü Do not take medicines
prescribed for someone
else. Do not give away or
sell your medicines.
Taking medicines that are prescribed to someone else, including a family
member, is illegal and can put you at risk for harmful side effects and
possible overdose and death. Keep your medicines in a safe and secure
location. If someone steals your opioids or your opioid prescription,
promptly report the theft to the police. Then, speak to your healthcare team
about your options because early refills may or may not be approved.
ü Avoid alcohol and
street drugs.
Combining opioids with alcohol, marijuana, or using “street drugs” can cause
severe harm or death. It is important that your provider know about all
substances you are taking. Your provider cannot safely continue prescribing
opioids if using these substances creates a safety concern.
ü Be informed about
the risk of developing
opioid dependence.
Anyone taking opioids can develop dependence. The risk goes up the
longer you take opioids and with higher doses. Treatments are available
for opioid dependence. Talk to your healthcare team if you feel this may be
happening to you\
Compiled by Jr Patatas
Facebook of Jr Patatas
Subscribe to:
Posts (Atom)