Get Up On It

Analgesics
Analgesics (pain medication)
Analgesics refer to a group of drugs used to temporarily relieve pain. They are sometimes known as painkillers. They block pain signals by changing how the brain interprets the signals and slowing down the central nervous system. Combining analgesics with alcohol, prescription or illegal drugs can create dangerous and unpredictable effects. Even low doses can impair driving ability. There are two main types of analgesics: non-narcotic and narcotic.

Non-narcotic Analgesics
Non-narcotic analgesics are used to reduce pain from headache, cold, flu, arthritis and many other conditions. They normally do not require a prescription and can be purchased over the counter (OTC). There are many OTC pain relieving products on the market, which are in tablet or capsule form. Recommended dosage is to repeat every 4 to 6 hours (if needed) with no more than 6 or 8 capsules or tablets taken within a 24 hour period. The pain relieving effects usually last 4 to 6 hours. When taken for no more than 10 days, these drugs can be a safe and effective method of reducing pain and fever. There are two major types: acetaminophen (Tylenol) and non-steroidal antiinflammatory drugs (ASA-Aspirin, Ibuprofen-Advil and naproxen sodium-Aleve). Acetaminophen relieves aches, pains and fever, but does not reduce swelling (inflammation). It is easier on the stomach than some other pain medications and is safer for children to use. If taken for a long period of time or in larger than recommended doses, acetaminophen can lead to liver or kidney damage. This risk is increased with regular alcohol use. High doses can lead to liver failure and death. Non-Steroidal anti-inflammatory drugs (NSAIDs) are useful for relieving pain, fever and inflammation. ASA has a stronger anti-blood clotting effect, making it useful as a blood thinner. One of the major drawbacks of NSAIDs is that they can cause stomach irritation and in some cases frequent use causes ulcers or internal bleeding. For this reason, pharmacists recommend taking them with meals. For those people, who cannot tolerate NSAIDs, it is suggested they take acetaminophen. The use of certain NSAIDs, such as Aspirin, in children with viral infections, is associated with Reye Syndrome. When pain tolerance exceeds the abilities of over the counter medications, prescription medications such as narcotic analgesics are considered.

Narcotic Analgesics
Narcotic analgesics are also known as opioid analgesics. They are used in medicine as strong analgesics, for relief of severe or chronic pain. Other medical uses include control of coughs (codeine, hydrocodone) and treatment of addiction to other opioids (methadone). Some opioids, such as morphine and codeine are made from opium, a thick white liquid extracted from the unripe seeds of the opium poppy, which grows in southern Asia. Other opioids are methadone, meperidine (Demoral), oxycodone (Percodan) (Percoset), hydromorphone (Dilaudid), fentanyl (Duragesic), pentazocine (Talwin), propoxyphene (Darvon), hydrocodone (Vicodin, Expectorant) are made in pharmaceutical laboratories and are only available by prescription. Some pain medications combine ASA and acetaminophen with small amounts of mild opioids such as codeine (222s, Atasol 8 and Tylenol 1). These medications are available without a prescription, but are kept behind the counter and available only through a pharmacist. Some prescription opioids, such as Fiorinal C, Vicodin and Peracet are also combined with ASA and acetaminophen to increase pain relief. Opioid medications can be taken orally in tablet or capsule form or injected. They are also available as skin patch, syrup, liquid and suppositories. When taken orally, the effects come on gradually and are felt in 10 to 20 minutes. When they are injected, the effects are felt almost immediately. Pain relieving effects vary in relation to the type of drug taken. Many opioids last up to 4 hours, while other time-release opioids, such as oxycodone last 12 hours. The dosage given for pain relief must be gradually increased, so that tolerance to the negative effects can develop. Opioids can provide an euphoric (feeling of pleasure) effect, making them susceptible to abuse. Street names include M, morph for morphine, meth for methadone, percs or Percodan or Percocet and juice for Dilaudid.

Effects
pain relief intense sense of well being, pleasure (euphoria) extreme sense of relaxation drowsiness, sedation dizziness, light headedness, loss of balance pinpoint pupils, blurred vision dry mouth nausea, vomiting, constipation, loss of appetite headache itching sweating difficulty with urination anxiety, depression decreased breathing and heart rate labored breathing hallucinations tremors, seizures loss of consciousness, coma

Long Term Effects

weight loss, malnutrition irritability, moodiness blurred vision, reduced night vision chronic constipation menstrual irregularities low sex drive, sexual problems depression poor concentration pain sensitivity, body is unable to make natural painkillers, small pains seem severe painful and frequent urination restlessness, sleeping problems kidney and liver damage death

Whenever injected drugs are used with shared needles, there is an increased risk of bacterial and viral infections such as hepatitis and HIV (the virus that causes AIDS).

Analgesics and Addiction

Non-narcotic analgesics are not addictive. When narcotic analgesics (opioids) are used occasionally under the guidance of a physician, they can be a safe and effective pain reliever. Regular use of opioids can be psychologically (the individual feels they need it) addictive and physically addictive (the individuals body needs it). Tolerance develops rapidly with regular narcotic analgesic (opiod) use, which means a person requires a greater amount of the drug to get the same effects or high.

Analgesics and Withdrawal

Non-narcotic analgesics are not physically addictive; therefore withdrawal effects are not experienced. Narcotic analgesics (opioids) are physically addictive, causing withdrawal symptoms such as craving, hot/cold sweats, uncontrollable coughing, yawning, sneezing, nasal discharge, muscle pain, insomnia, diarrhea, stomach pain, nausea, vomiting, sweating, chills, fever, tremors, increased blood pressure and heart rate, anxiety, depression, restlessness and irritability. The type of opioid used determines when withdrawal symptoms occur and their intensity. Withdrawal symptoms usually last 7 to 10 days. It is important to see a doctor to discuss a plan for gradually cutting back. A reduction in dose over time is recommended to lessen the severity of the withdrawal symptoms. Methadone maintenance treatment is also an option for those addicted to opioids. It may take 6 months or longer for total withdrawal to occur completely. For more detailed information see Get Up On It Methadone.

Analgesics and Treatment

In Newfoundland and Labrador, drug treatment primarily focuses on supporting an individual to achieve a drug free lifestyle with improving quality of life as the primary goal. The treatment may focus on abstinence goals or reducing the harms and risks associated with alcohol, other drug use and gambling. Treatment options include individual counseling, group therapy, detoxification, inpatient treatment, day treatment, drug therapy and self help groups. Finding the best option for individuals often requires a combination of approaches.

Analgesics, Pregnancy and Breastfeeding

Non-narcotic analgesics are safe during the first and second trimesters when used occasionally in recommended doses. The risks increase as more is taken. However, taking non-steroidal anti-inflammatory drugs (NSAIDs) such as ASA during the last trimester could cause bleeding. The use of narcotic analgesics (opioids) during pregnancy, may affect the fetus. There is no known safe level of opioid use during pregnancy. It is recommended not to use opioids during pregnancy. If the mother is being treated for chronic pain, she may wish to explore other, safe options such as methadone. Narcotic analgesics may increase the risk of complications during delivery, miscarriage, premature delivery and stillbirth. The infant may have low birth weight, difficulty breathing, be extremely drowsy or experience withdrawal symptoms. There is little known about the long term effects of opioid use during pregnancy. Occasional prescribed use of opioids during breastfeeding may be safe, however regular use is not advised. Even occasional use of opioids may cause drowsiness in the baby. Physician monitored codeine and methadone use are relatively safe when breastfeeding. Expectant and nursing mothers should consult with their doctor, even if the drug has been prescribed.

Analgesics and the Law

Non-narcotic analgesics are available without a prescription. It is not illegal to use narcotic analgesics (opioids) when prescribed by a physician. However, according to the Controlled Drugs and Substances Act, it is illegal to obtain prescribed opioids without an authorized prescription. It is also illegal to obtain any prescription drug containing opioids without notifying the physician that you have received a similar prescription within the last 30 days. Possessing and selling narcotic analgesics for the purposing of trafficking is a criminal offense.

Sources

abcs of Opioid drugs (analgesics), Alberta Alcohol and Drug Abuse Commission, 2007. abcs of Over-the-Counter Drugs, Alberta Alcohol and Drug Abuse Commission, 2006. Do You KnowOpioids, Centre for Addiction and Mental Health, 2003. Drugs & Drug Abuse: A Reference Text-3rd Ed, Centre for Addiction and Mental Health, 1998. Effects Series: Opioids, Alberta Alcohol and Drug Abuse commission, 2007. Facts of Analgesics (Painkillers), The, About.com, Arthritis, 2006. Is it Safe for My Baby, Centre for Addiction and Mental Health, 2003. Opioid Use During Pregnancy, Childrens & Womens Health Centre of British Columbia, 2003. Over the Counter Drugs: Straight Talk From Your Doctor, British Columbia Medical Association, 2005. Prescription Pain and Other Medications, NIDA InfoFacts, National Institute of Drug Abuse, U.S. Department of Health and Human Services, 2006. Straight Facts About Drugs and Drug Abuse, Health Canada, 2000.

Permission is granted to photocopy or cite this publication, provided the source is identified. For additional information and services contact the Mental Health and Addictions Program with your local Regional Health Authority or go online at: www.addictionhelpnl.ca or www.getuponit.ca.

2009