2 Opioid Analgesics
Learn when opioid analgesics may be used, how treatment is prescribed and monitored, and how to recognize and respond to overdose risks.
When opioids may be used
, including morphine, oxycodone, hydrocodone, and fentanyl, may be used for some acute pain and, in selected cases, subacute or chronic pain. For many common conditions, nonopioid or nonpharmacologic treatments are preferred, or may be used alongside an opioid.
Decisions about opioid treatment should consider both expected pain relief and the patient’s ability to function, along with individual risks. An opioid is appropriate only when its expected benefits justify its risks.
Starting and limiting treatment
When starting opioid therapy, an is preferred over an extended-release or long-acting product. If an opioid is appropriate, use the lowest effective dose. For acute pain, prescribe no more than is needed for the expected period of pain that requires opioid treatment.
Treatment should be individualized rather than based on a fixed course length for everyone with the same diagnosis. The choice to use an opioid should account for expected benefits and risks.
Effects and interaction risks
can cause constipation, drowsiness, impaired judgment, and nausea. They can also slow breathing; severe is a medical emergency.
Alcohol and sedating medicines can add to opioid-related sedation and breathing suppression, increasing overdose risk. Patients should review all medicines and substances with a clinician or pharmacist and avoid unsafe combinations.
Monitoring benefits and risks
After starting or changing opioid treatment, reassess pain relief, function, and adverse effects. A lower pain score alone does not establish that treatment is beneficial overall; for example, drowsiness that prevents usual activities matters when evaluating the balance of benefits and harms.
Review the patient’s medicines and relevant overdose risks. Consider information as appropriate, discuss overdose prevention, and consider whether is appropriate. Risks can change over time, so a dose that was previously tolerated is not necessarily still safe after a medication or health-status change.
Changing or reducing treatment
Regular opioid use can lead to , and sudden discontinuation may cause withdrawal. If the risks of continued treatment outweigh the benefits, any change should be individualized and planned with the clinician. When appropriate, work with the patient on a gradual dose reduction; abrupt discontinuation and rapid dose reductions should generally be avoided unless an urgent, life-threatening safety concern requires immediate action.
Patients should not adjust the dose independently. Follow-up should continue to assess both benefits and harms and to revisit safety risks.
Responding to a possible overdose
A person who is difficult to wake and has slow, shallow breathing may be experiencing an opioid overdose. Call 911 immediately, give if available, and stay with the person while emergency help is coming.
Do not leave the person to sleep it off or give them another opioid dose, alcohol, or a sedative.