Dear Doctors: I am going to have a major abdominal surgery. My doctor says it is likely that I will be needing strong pain medications after. My question is about opioids: How long can you take them and not get addicted? What is the best way to stop so you don’t have side effects?
Dear Reader: Opioids are a class of drugs whose primary use is to treat pain that is moderate or severe. They work by binding to receptors in the brain and the body, which eases the intensity of pain signals received by the brain. Opioids also suppress certain chemical reactions in the cough center of the brain stem, making them effective for managing severe or chronic cough. And because opioids activate receptors that slow the progress of food moving through the gut, they are sometimes used to manage severe diarrhea.
Unfortunately, as the crisis of the opioid epidemic illustrates, these drugs are highly addictive. As they confer the medical benefits we discussed, they activate reward centers of the brain. This produces feelings of euphoria and profound well-being that people can come to crave. At the same time, the body is building up a tolerance to the drugs. This creates a feedback loop in which increased usage delivers diminishing rewards. Longtime use of opioids actually alters the working of the brain’s reward system, eventually making the drugs the only thing that allows the user to feel pleasure. All of this means the safe use of opioids requires careful consideration, advance planning and ongoing oversight.
Taking opioid medications for a week or less typically does not create a problem. You should be able to stop the drugs without physical side effects. It is important to use them exactly as prescribed, and never increase dosage or frequency. If longer-term use has proven necessary, your doctor should craft a taper schedule to ease off the drugs. This involves a planned series of gradually decreased dosages, during which you monitor pain levels and side effects. During this process, patients are often also switched to alternative, nonopioid pain medications. Research shows that including drug-free treatments -- such as acupuncture, physical therapy, mindfulness practices and meditation -- is also very helpful.
Physical symptoms when weaning off opioids can include anxiety, irritability, restlessness, nausea, abdominal discomfort, muscle cramps or spasms, chills, night sweats, rapid heartbeat, changes to blood pressure and poor or disordered sleep. Stopping the drugs can adversely affect the emotions and increase the risk of suicidal thoughts.
When ending opioid use that lasts more than a week to 10 days, it is very important to closely adhere to the prescribed taper plan. Immediately discuss any difficulties with your doctor. This includes both physical side effects and any signs of dependence. Your medical team can make appropriate adjustments to the taper plan, including alternative medications, to help ensure your success in stopping the opioid drug.
Finally, it is important to understand that alternative pain management programs exist. If you are not comfortable using opioids for post-surgical pain, make this clear to your medical team and ask to explore a different approach.
(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)
