properties, some of these drugs—codeine and diphenoxylate (Lomotil®), for example—are used to relieve coughs and severe diarrhea.
How do opioids affect the brain and body? Opioids act by
attaching to and activating opioid receptor proteins, which are found on nerve cells in the brain, spinal cord, gastrointestinal tract, and other organs in the body. When these drugs attach to their receptors, they inhibit the transmission of pain signals. Opioids can also produce drowsiness, mental confusion, nausea, constipation, and respiratory depression, and since these drugs also act on brain regions involved in reward, they can induce euphoria, particularly when they are taken at a higher-than- prescribed dose or administered in other ways than intended. For example, OxyContin® is an oral medication used to treat moder- ate to severe pain through a slow, steady release of the opioid. Some people who misuse OxyContin® intensify their experience by snorting or injecting it. This is a very dangerous practice, greatly increasing the person’s risk for serious medical complica- tions, including overdose.
What are the possible consequences of prescription opioid
misuse? When taken as prescribed, patients can often use opioids to manage pain safely and effectively. However, it is possible to develop a substance use disorder when taking opioid medications as prescribed. This risk and the risk for overdose increase when these medications are misused. Even a single large dose of an opioid can cause severe respiratory depression (slowing or stop- ping of breathing), which can be fatal; taking opioids with alco- hol or sedatives increases this risk.
When properly managed, short-term medical use of opioid
pain relievers—taken for a few days following oral surgery, for instance—rarely leads to an opioid use disorder or addiction. But regular (e.g., several times a day, for several weeks or more) or longer-term use of opioids can lead to dependence (physical discomfort when not taking the drug), tolerance (diminished ef- fect from the original dose, leading to increasing the amount taken), and, in some cases, addiction (compulsive drug seeking and use). With both dependence and addiction, withdrawal symptoms may occur if drug use is suddenly reduced or stopped. These symptoms may include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps, and involuntary leg movements.
Misuse of prescription opioids is also a risk factor for transi- tioning to heroin use.
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Central Nervous System (CNS) Depressants
What are CNS depressants? Central nervous system (CNS) depressants, a category that includes tranquilizers, sedatives, and hypnotics, are substances that can slow brain activity. This prop- erty makes them useful for treating anxiety and sleep disorders. The following are among the medications commonly prescribed for these purposes:
Benzodiazepines, such as diazepam (Valium®), clonazepam (Klonopin®), and alprazolam (Xanax®), are sometimes pre- scribed to treat anxiety, acute stress reactions, and panic attacks. Clonazepam may also be prescribed to treat seizure disorders. The more sedating benzodiazepines, such as triazolam (Hal-
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How is prescription opioid misuse related to chronic pain? Health care providers have long wrestled with how best to treat the more than 100 million Americans who suffer from chronic pain. Opioids have been the most common treatment for chron- ic pain since the late 1990s, but recent research has cast doubt both on their safety and their efficacy in the treatment of chron- ic pain when it is not related to cancer or palliative care. The potential risks involved with long-term opioid treatment, such as the development of drug tolerance, hyperalgesia, and addiction, present doctors with a dilemma, as there is limited research on alternative treatments for chronic pain. Patients themselves may even be reluctant to take an opioid medication prescribed to them for fear of becoming addicted. Estimates of the rate of opioid addiction among chronic pain
patients vary from about 3 percent up to 26 percent. This vari- ability is the result of differences in treatment duration, insufficient research on long-term outcomes, and disparate study populations and measures used to assess nonmedical use or addiction. To mitigate addiction risk, physicians should adhere to the
CDC Guideline for Prescribing Opioids for Chronic Pain. Before prescribing, physicians should assess pain and functioning, con- sider if non-opioid treatment options are appropriate, discuss a treatment plan with the patient, evaluate the patient’s risk of harm or misuse, and coprescribe naloxone to mitigate the risk for overdose. When first prescribing opioids, physicians should give the lowest effective dose for the shortest therapeutic duration. As treatment continues, the patient should be monitored at regular intervals, and opioid treatment should be continued only if meaningful clinical improvements in pain and functioning are seen without harm.
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