What are opioids?
Opioids are strong medicines meant to be used to manage moderate to severe pain. Examples include oxycodone, hydrocodone, morphine, hydromorphone, fentanyl, codeine and tramadol. You may hear opioids referred to as narcotics, pain killers or controlled substances.
Opioids primarily reduce pain by interrupting central nervous system signals between the brain and the body. When opioids enter the bloodstream, they work their way toward nerve cells and attach themselves to opioid receptors (anchoring points on the surface of the cells). When opioids bind to these receptors, they trigger a series of reactions that block pain sensations.
Opioids have received significant media attention over the past decade due to their high rate of complications which can include death or addiction. However, when prescription opioids are used in the right patient, for the right indication, at the right dose, in the right form and for the right length of period, they are one of the most effective pain tools available to help control short term pain. When taken properly, opioids can be an effective part of a comprehensive pain management plan.
Opioids are most effective when used for Acute pain which is short-term pain that resolves after a few hours or days. For example, you may be prescribed opioids for a short time after a surgery. Opioids have very little benefit when used daily for Chronic pain (pain that lasts more than 45 to 90 days) outside of pain caused by advanced stage cancer or other progressive, long-term conditions.
Chemists, pharmacologists and medical professionals have several ways to classify opioids, but the easiest
distinction is around how opioids are made. Opioids are made in three main ways:
- Natural opioids. These opioids are made from the opium poppy plant. They include morphine, opium and heroin.
- Synthetic opioids. Created in a laboratory and completely developed through chemical processes, this category of opioids includes fentanyl and methadone.
- Semi-synthetic opioids. Opioids such as oxycodone, hydrocodone and hydromorphone are made from opium plants that have been chemically changed from the original poppy plan
Opioids are also categorized by frequency, or how often doses are necessary:
- Long-acting opioids. Prescribed for people who expect to have long-term pain, such as cancer pain, extended-release (ER) or sustained-release (SR) medicines stay in the bloodstream at a steady concentration for longer periods of time.
- Short-acting opioids. Immediate-release opioids only stay in the bloodstream for short periods. They’re often used for short-term treatment of moderate to severe pain, such as after an injury or a surgery.
Doctors prescribe different opioids in different circumstances. Here is an example opioids list based on the level of pain.
- Long-acting opioids. Prescribed for people who expect to have long-term pain, such as cancer pain, extended-release (ER) or sustained-release (SR) medicines stay in the bloodstream at a steady concentration for longer periods of time.
- Short-acting opioids. Immediate-release opioids only stay in the bloodstream for short periods. They’re often used for short-term treatment of moderate to severe pain, such as after an injury or a surgery.
Moderate to severe acute pain
- Codeine.
- Morphine.
- Hydromorphone (Dilaudid).
- Hydrocodone and acetaminophen.
- Oxycodone (Oxaydo, Roxicodone, Roxybond).
- Oxycodone and acetaminophen (Percocet).
Chronic pain
- Buprenorphine (Belbuca, Butrans).
- Methadone (Methadone HCl Intensol).
- Hydrocodone extended release (Hysingla ER).
- Morphine extended release (MS Contin).
- Tapentadol extended release (Nucynta ER).
- Oxycodone extended release (OxyContin, Xtampza ER).
When used as part of medical care, opioids are legal. However, opioids are controlled substances. This means they’re federally regulated and can only be prescribed or administered by people who have a license to do so — such as a doctor or pharmacist. Many opioids now available on the streets have no legitimate medical purposes and are considered illegal by the federal government. Examples include heroin and a number of novel compounds such as fentanyl.
© 1998-2024 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved
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