What are opioid medications (Opioid Analgesics)?

From the Guidelines

Opioid medications should be used at the lowest effective dose for the shortest duration possible, with a focus on minimizing risks of long-term opioid use and maximizing non-opioid pharmacologic and nonpharmacologic therapies. When prescribing opioids for acute pain, clinicians should prioritize immediate-release formulations and limit the duration of use to the expected duration of pain severe enough to require opioids 1. For patients with acute pain, short-acting opioids like hydrocodone 5 mg/acetaminophen 325 mg, one tablet not more frequently than every 4 hours as needed, may be sufficient 1.

Key Considerations for Opioid Use

• Clinicians should work with patients to prevent prolonged opioid use and encourage opioid tapering if opioids are used around the clock for more than a few days 1.
• Patients should be advised about the risks of opioid use, including constipation, nausea, sedation, and respiratory depression, as well as the potential for physical dependence and addiction 1.
• Naloxone should be co-prescribed for patients at higher risk of overdose, and clinicians should consider concurrent medical conditions, such as sleep apnea, pregnancy, and substance use disorders, when assessing risks of opioid therapy 1.
• Non-opioid pain management strategies, such as nonsteroidal anti-inflammatory drugs and acetaminophen, should be utilized whenever possible before initiating opioid therapy 1.

Special Considerations for Patients Receiving Maintenance Opioid Therapy

• For patients receiving maintenance methadone or buprenorphine therapy, uninterrupted therapy should be continued to address the patient's baseline opioid requirement, and aggressive pain management should be implemented 1.
• Mixed agonist and antagonist opioid analgesics should be avoided, as they may precipitate acute opioid withdrawal in patients receiving maintenance opioid therapy 1.
• Combination products of opioid analgesics containing fixed doses of acetaminophen and an opioid should be limited to patients not requiring large doses to avoid acetaminophen-induced hepatic toxicity 1.

From the FDA Drug Label

Addiction, Abuse, and Misuse Morphine sulfate tablets expose patients and other users to the risks of opioid addiction, abuse, and misuse, which can lead to overdose and death Assess each patient's risk prior to prescribing morphine sulfate tablets and monitor all patients regularly for the development of these behaviors and conditions Opioid Analgesic Risk Evaluation and Mitigation Strategy (REMS): To ensure that the benefits of opioid analgesics outweigh the risks of addiction, abuse, and misuse, the Food and Drug Administration (FDA) has required a REMS for these products

• Opioid medications can lead to addiction, abuse, and misuse, resulting in overdose and death.
• It is essential to assess each patient's risk before prescribing opioid medications and monitor them regularly for signs of addiction, abuse, and misuse.
• The Opioid Analgesic Risk Evaluation and Mitigation Strategy (REMS) is required by the FDA to ensure that the benefits of opioid analgesics outweigh the risks of addiction, abuse, and misuse 2.

From the Research

Opioid Medications

• Opioid medications are commonly used for pain management, but their use can be complicated by factors such as opioid use disorder, renal dysfunction, and respiratory depression 3, 4, 5.
• The management of acute pain in patients taking medication for opioid use disorder can be challenging, and evidence suggests that continuing methadone or buprenorphine during acute pain episodes may be beneficial 3.
• Buprenorphine is considered a top-line choice for opioid treatment in the elderly due to its favorable pharmacological profile and lower risk of respiratory depression 4.
• Opioid analgesics can interact with other medications, and healthcare providers should be aware of potential drug interactions to ensure safe and effective pain management 6.
• Methadone is a unique opioid with a complex pharmacology, and its use requires careful consideration of dosing, monitoring, and potential interactions with other medications 5.

Safety and Efficacy

• The safety and efficacy of opioid medications can vary depending on the specific medication, dose, and patient population 4, 7, 5.
• Opioid medications can be effective for managing chronic pain, but their use should be carefully monitored and tapered as needed to minimize risks 7.
• Healthcare providers should be aware of the potential risks of opioid medications, including respiratory depression, immunosuppression, and addiction 4, 6, 5.

Clinical Considerations

• Healthcare providers should consider individual patient factors, such as renal function, hepatic function, and mental health status, when prescribing opioid medications 3, 4, 5.
• Opioid medications should be used in conjunction with other pain management strategies, such as non-pharmacological interventions and adjuvant medications, to optimize pain control and minimize risks 3, 7.
• Further research is needed to better understand the optimal use of opioid medications for pain management and to develop evidence-based guidelines for clinical practice 3, 7, 5.