There's no question that the prescription drugs known as opioids can offer tremendous benefit for many people coping with moderate to severe pain. More potent as pain relievers than either acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, these narcotic drugs—which include oxycodone (OxyContin), oxycodone combined with acetaminophen (Percocet) and hydrocodone (Vicodin)—are commonly prescribed to relieve cancer pain or pain following surgery. Increasingly, opioid analgesics have also been prescribed for chronic pain, such as pain stemming from severe arthritis, a bad sprain or low back pain or pain that persists long after an injury.

Other common opioids include morphine, codeine, hydromorphone (Dilaudid), methadone, tramadol (Ultram) and transdermal fentanyl (Duragesic). Opioids are widely prescribed: The Food and Drug Administration (FDA) estimates that nearly 23 million prescriptions for extended-release and long-acting opioids were issued in 2011. Opioids are also widely misused and abused, as a multitude of news stories have made clear, to the point where opioid overdose has been declared a public health epidemic by the Centers for Disease Control and Prevention.

Almost all available opioids are associated with a risk of abuse and overdose. Side effects associated with opioids include confusion, impaired balance, drowsiness, nausea and constipation—all of which can be magnified if an opioid isn't taken as prescribed. Overdose can also slow down breathing enough to be fatal.

Are you vulnerable?

Although many stories about prescription drug abuse involve young people, adults over 65 are also at risk. They not only take more prescription drugs than any other group, but they take more potentially addictive medications—including opioids—that can lead to abuse.

In one study, published in March 2012 in the Archives of Internal Medicine, researchers looked at data on nearly 400,000 patients 66 years and older in Ontario, Canada, who had undergone short-stay surgical procedures such as cataract surgery, varicose vein stripping and transurethral resectioning of the prostate—procedures not generally associated with long-term postoperative pain.

None of the patients had used opioids during the previous year. Within a week following the surgery, about 7 percent of the patients were prescribed opioids, most commonly codeine and oxycodone; a year later, those patients were 44 percent more likely to be using the drugs than patients who didn't receive opioids during recovery. The researchers also found that the use of oxycodone among patients had increased (from 5.4 to 15.9 percent) during that same time.

Patients who began taking NSAIDs after surgery were also more likely to become long-term NSAID users compared with patients who hadn't been prescribed NSAIDs. But, notably, a far smaller percentage of patients were prescribed NSAIDs postsurgically than were prescribed opioids.

The study didn’t answer why a sizeable group of older patients who were given opioids after surgeries that weren't associated with long-term pain were still taking opioids a year later. But using opioids nearly always leads to drug dependence, physically and psychologically, even when the drugs are taken as prescribed.

This means that stopping the drugs will trigger withdrawal symptoms, such as pain, restlessness and nausea. These symptoms can be eliminated by gradually tapering the dosage once pain relief is no longer needed.

Psychological dependence, the sense that a specific psychoactive substance is needed, can become the real problem. Psychological dependence tends to occur only when opioids are used in excessive amounts, and it generally develops after the need for pain relief has passed. In some people, this can lead to addiction—which occurs when neither your mind nor your body can function without the drug and its use becomes compulsive.

In July 2014, the Centers for Disease Control and Prevention (CDC) issued a press release indicating that opioid pain reliever prescription rates vary considerably among states in the U.S. According to the CDC, more research is needed to determine why some states have higher-than-normal narcotic prescription rates—which correspond with higher rates of overdose—and how to address this problem.

Source: Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50; Updated by Remedy Health Media

Publication Review By: the Editorial Staff at

Published: 20 Jul 2013

Last Modified: 28 Jan 2015