Opioids are safe, excellent painkillers once the right dose is found. About one-fifth of people living with pain need them for enough relief. Only 1-3% of patients become addicted. So the job is to spot the high-risk patients, not to abandon the drug.
In recent years, doctors have been told to cut back on opioids for pain because they are seen as addictive painkillers. They are told to use other, weaker drugs instead. So it is natural to ask whether opioids are really that good for pain.
First, it is vital to know that opioids are among the oldest painkillers humans have used. Opioids are good for more than pain. They also calm cough, control diarrhea and help many other health problems.
Pain is not a disease. It is a symptom. Still, many health problems cannot be cured, so pain is one of the most common reasons people see a doctor. Almost half of all patients who visit a doctor’s office have some pain.
Today, the approach to treating pain is fairly simple. Doctors use the so-called pain-treatment ladder. First, they start with non-steroidal anti-inflammatory drugs (NSAIDs). If these fail, they move to weaker opioids like tramadol. Finally, they prescribe opioids. So doctors use opioids when other efforts have failed to give enough chronic pain relief.
Studies suggest about one-fifth of all people living with pain need opioids for enough pain relief. But doctors are now under pressure to cut opioid use. They are already tapering opioids in many patients and avoiding them in new patients. Yet there are worries that treating opioids as addictive painkillers may be causing more harm than good.
It is true that 1-3% of patients may become addicted to these drugs. But that does not mean most patients must suffer because a small number are at risk of addiction. Most people addicted to opioids are also likely to keep abusing various substances. If they do not get prescription drugs, they are likely to use street drugs. There is not enough evidence that these people became addicted just because doctors prescribed opioids.
Many studies show that opioids are excellent and safe painkillers. But some patients are prone to opioid addiction because of genes or other reasons. Many people with chronic pain also have depression, anxiety and other mental health problems. That makes them prone to addiction.
So instead of stopping opioids or stopping prescribing, we just need to spot the high-risk patients.
People break down opioids very differently. For some, a small dose is enough for pain relief. Others need much higher doses. Still, opioids work very well for pain once the right dose is found.
Because people break down these drugs differently, some people are naturally prone to depending on them.
In recent years, some experts have talked about drug tolerance and opioids causing hyperalgesia (extra sensitivity to pain). But there is little data showing these things happen or matter much in practice. They may also happen in only a small number of patients. So they are not reasons to stop prescribing opioids for chronic pain relief.
The truth is that opioids cause very few side effects in most patients. These include constipation, sleepiness, poor focus, nausea and low sex drive. Most of these side effects are not severe and can be managed in different ways. For example, some patients may have their dose adjusted. Others may be given a different opioid.
Many problems with opioids come from how sensitive each person is, and sadly many doctors do not know this. So if a patient cannot tolerate one opioid, another one can be used. It must also be understood that no single dose fits everyone. With opioids, finding the right dose is hard because people differ so much.
In short, opioids are safe and excellent painkillers. But people differ hugely. For example, some need opioids at a much higher dose. And some are prone to addiction. For them, getting opioid addiction treatment must not be ignored. So these differences must be understood for safe opioid use.
Frequently asked questions
Are opioids addictive?
For most patients, no. Only 1-3% of patients prescribed opioids become addicted. Those people are often prone to it because of genes, depression, anxiety or other mental health problems. Many of them are likely to use other substances too. That small group needs to be spotted early and treated for addiction. It is not a reason to deny pain relief to everyone else.
What do opioids do to your body?
Opioids are among the oldest painkillers humans have used. Besides easing pain, they calm cough and control diarrhea. The common side effects are constipation, sleepiness, poor focus, nausea and low sex drive. Most are not severe. They can be managed by adjusting the dose or switching to a different opioid, because people react very differently to each one.
Why do some people need a higher opioid dose than others?
Because people break down opioids very differently. For some, a small dose is enough to control pain. Others need a much higher dose for the same relief. No one dose fits everyone, which is why finding the right one takes care. Once it is found, opioids are safe and excellent painkillers. A patient who cannot tolerate one opioid can often use another.
Related reading
Ketorolac Reduces Opioid Use After Surgery · Chemists Likely Found A Way To Make Opioids Less Addictive · Early Chronic Pain Risk Identification Cuts Opioid Use · How Chronic Pain and Opioid Addiction Are Related
The Bottom Line
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