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    How to use opioids safely

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If you are taking opioids or talking with your health care provider about this treatment option, now is the time to plan for safe use and disposal of these medications. Practicing caution can mean the difference between life and death for you, your loved ones and your neighbors.

Opioid painkillers are highly addictive. After just five days of prescription opioid use, the likelihood that you'll develop long-term dependence on these drugs rises steeply — increasing your risk of eventual addiction and overdose. And you don't need a prescription to be at risk. Most people who misuse prescription painkillers report getting them from a family member or friend. Find out what steps to take to keep you and your loved ones safe.

Before you start a course of opioids
Opioids aren't safe for some people. Your medical, family and personal history of substance use all help determine whether opioids are safe for you.

It’s important that health care providers prescreen populations before they initiate these drugs. "So there are a variety of things that physicians need to consider when they initiate a course of opioid therapy," says Dr. Holly Geyer, a Mayo Clinic addiction medicine specialist. "It's always a concern when patients have histories that predispose them to having secondary complications from using opioids. Issues with drug and alcohol abuse, active issues, or prior issues, and family history issues with drug and alcohol abuse, problems with sleep disorders or primary lung problems can predispose a patient to issues."

Watch: Dr. Holly Geyer discusses how to use opioids safely.

Journalists: Broadcast-quality sound bites are in the downloads.

Medical conditions that increase your risk of dangerous side effects from opioid medications include:

  • Sleep apnea.
  • Obesity.
  • Anxiety or depression.
  • Fibromyalgia.

Mental health and substance abuse problems that increase your risk of opioid abuse and addiction include:

  • History of severe depression or anxiety.
  • Heavy tobacco use.
  • Prior drug or alcohol rehabilitation.
  • Family history of substance abuse.
  • Personal history of substance abuse.

Your health care provider will ask about all of these risk factors before prescribing any new opioid medication. Be honest, and don't be afraid to ask your own questions. The safest time to prevent opioid-related problems is before you start these medications.

What to expect from your health care provider
When a health care provider begins a therapy for a patient related to a controlled substance, it’s always important that, No. 1, they prescreen the patient and that, No. 2, they follow that patient closely throughout the course of therapy.

"There are many things that we as providers will likely do with a patient at the beginning of therapy," says Dr. Geyer. "That includes sitting down with them, and discussing the risks and the benefits of initiating either an opioid or another controlled substance. And then going through what we consider a prescription monitoring program, which is an online database of all the drugs that are controlled substances the patient may have received in the past year or past few years."

The Centers for Disease Control and Prevention (CDC) provides guidance to health care providers for safe prescribing of opioid medications. Following the CDC's recommendations, you should expect your health care provider to:

  • Prescribe the lowest effective dose, for the shortest period needed, when treating acute pain. In most cases, acute pain, such as pain that follows surgery or a bone fracture, is not severe enough to require opioids for more than three days.
  • Avoid or delay prescribing opioids for chronic pain. These medications are not often safe or effective for chronic pain unrelated to cancer or cancer treatments. Your health care provider should help you evaluate many other therapies, including nonpharmacological treatments and nonopioid medications, before considering a trial of opioids.
  • Work with you to establish realistic treatment goals. Your health care provider should help you determine how much pain relief you need to improve your ability to function and quality of life. There's no cure for chronic pain — even with drugs as powerful as opioids. And there are risks associated with all pain medications. You and your health care provider should partner in maximizing your enjoyment of life, while minimizing medication-related health risks.
  • Ask you to sign an opioid therapy agreement before you start a long-term course of opioid medications. Typically, these agreements clearly state your responsibilities while using opioid medications. You'll agree to use opioids only as prescribed and obtain painkillers from only one health care provider and one pharmacy. You'll acknowledge that you won't receive additional medication until your current prescription runs out — even if your medication is lost or stolen. You may be asked to submit to periodic urine tests and pill counts. You'll agree to maintain all aspects of your treatment plan, such as physical therapy or behavioral medicine, and keep all scheduled follow-up appointments. Violating these terms may prompt termination of opioid therapy.
  • Schedule regular checkups while you're taking opioids. Expect your health care provider to require a follow-up appointment one to four weeks after you start opioid therapy to evaluate the benefits and risks of these medications. If you continue taking opioids, your health care provider will need to continue seeing you frequently — either with every prescription refill or every three months for as long as you use these drugs. These visits may include urine tests.
  • Help you minimize withdrawal when you stop opioids. If you've taken opioids for chronic pain and determine it's time to stop, your health care provider should help you slowly and safely taper off these drugs to avoid potentially severe side effects.

Dr. Geyer says Mayo Clinic will engage in chronic opioid prescribing guidelines over the next year, which will include patients following up every three months. “Ultimately, the goal is to have the patient transitioned off the opioid, and, so, when patients are starting to respond to therapy or when other therapies that have been integrated into this start to have their full effect, the goal is to reduce the opioids in noncancer populations," says Dr. Geyer.

What you can do to safely manage your medications
You play a critical role in ensuring your safety while taking opioids. Your health care provider and pharmacist can't help you stay safe if they don't have complete and current information about all your medications.

"So it’s important that when you bring those medications home, they’re stored in a safe and locked place, so that other individuals don’t have access to that," says Dr. Geyer. "Take the medications as prescribed, and if you’re approved by your physician to start de-escalating on your own when you don’t have ongoing pain, feel free to do so. You don’t need to take the entire bottle of pills."

When a medication has expired or you've stopped using it, dispose of it properly. Options for leftover medications include bringing them back to a facility that has a drug disposal take-back program or making sure the medications are destroyed. Sometimes the medications can be flushed down the toilet. This option is reportedly better than in the trash where someone can retrieve them.

Take these steps with your health care providers:

  • Tell all of your providers about all of the drugs you're taking. Opioids interact dangerously with many medications. For example, combining opioids with medications used to treat anxiety or sleep issues can be harmful or deadly. If you see different health care providers, each provider must be aware of all the medication you're taking, including over-the-counter medications such as aspirin, allergy medicine and nutritional supplements. Be honest about your alcohol use and any illegal substances you use.
  • Order all your medications through the same pharmacy whenever possible. The pharmacy has systems in place that alert pharmacists to potentially dangerous interactions among the drugs you're taking.
  • Read the instructions and warnings on the drug safety information sheet stapled to your prescription. These instructions notify you about potential side effects and help you understand how to check your response to the medication.
  • Report side effects to your health care provider right away. If you have any side effects, such as constipation, nausea, mood changes or confusion, contact a member of your health care team immediately.
  • Check the expiration date on your pill bottle. Medication loses its effectiveness over time, and its effects become unpredictable.

This article is written by Mayo Clinic staff. Find more health and medical information on mayoclinic.org.