Opioids come with risks all providers know and should clearly explain to all patients when prescribing them including increased tolerance, dependence and addiction. Opioid use disorder is a serious medical condition of addiction defined as not being able to abstain from using opioids, and having behaviors centered around opioid use that interfere with daily life including ugly withdrawal symptoms. It may be diagnosed by a physician, which may be confusing if it is diagnosed by the same physician prescribing the opioids. These drugs affect every single body system from the brain and lungs to the immune system. Long term effects of opioids include addiction, infections in the heart and or lungs, muscle pain and severe chronic constipation called opioid induced constipation that affects approximately 50% of patients on opioids. These effects don’t include the psychological aspects from taking opioids.
Opioids can interact with other diseases and should only be taken for short periods of three to five days as needed for pain. Because of our society’s overall poor health, sedentary lifestyles and taking so many prescribed medications in the United States, older adults are at a higher risk for accidental misuse or abuse of opioids. The elderly typically take multiple prescriptions for chronic diseases, increasing the risk of drug-drug and drug-disease interactions. They also have a slowed metabolism that affects the breakdown of the drug, increasing the risk of accidental overdose and deaths. Medical conditions that increase the risk of dangerous side effects from opioids include sleep apnea, obesity, anxiety or depression and fibromyalgia, which are conditions often seen in medical record reviews.
Mental health and substance abuse problems that can increase the risk of opioid abuse and addiction include a history of severe anxiety or depression, heavy tobacco use, prior drug or alcohol rehab and personal or family history of substance abuse. It is uncommon for patients with any or all of these to volunteer this information to their physician prescriber. One of the biggest risks and complications when taking opioids is respiratory slowing and depression that can lead to respiratory failure, cardiac arrest and a fatal overdose.
Common signs of opioid addiction include the following:
- Inability to control opioid use
- Frequently calling for refills prior to renewal
- “Drug-seeking behavior”
- Uncontrollable cravings
- Weight loss
- Drowsiness/sleep habit changes
- Lack of hygiene
- Frequent flu-like symptoms
- Decreased libido
- Isolation from family and/or friends
- New financial difficulties
- Stealing from family, friends or businesses
- Relationship and job losses
Opioid withdrawal can happen when the prescription is finished prior to the refill date. These drugs are not meant to be used long-term and cannot be stopped abruptly without having instant withdrawal symptoms. Many of these symptoms may be severe but are not considered life-threatening. Chronic use of opioids can lead to the development of an incapacitating form of dependence called opioid withdrawal syndrome, which is a life-threatening condition. Each patient receiving opioids is supposed to also be prescribed Narcan (also called Naloxone), which is an opioid antagonist used to treat an overdose in an emergency situation. Narcan can be given by a family member or friend. Every state has a prescription monitoring program (PMP) that pharmacists and other providers can access to make sure patients aren’t filling multiple narcotic prescriptions from multiple providers.
An important part of the treatment of chronic pain with opioids includes the pain contracts that patients have with the prescribing provider. Pain is considered chronic when it lasts longer than three months. Per the CDC, chronic opioid use is measured as 45 or more prescription days in the 90 days after the injury. The pain contract includes monthly or bi-monthly urine drug screens (UDS) to ensure they are taking their medications as prescribed. For example, if Oxycodone is prescribed, the drug shows up in the UDS to verify they aren’t selling it or stockpiling it, and shows they not taking additional medications like benzodiazepines, cannabis, etc. that would violate the contract. Legal nurse consultants can assist attorneys with identifying if pain contracts and urine drug screen tests were properly used during opioid treatment. They can also determine if Narcan was prescribed to prevent overdoses.