Opioids and Your Medications Can Be a Bad Mix

Try these alternatives for the three major types of pain

Opioids and Your Medications Can Be a Bad Mix

Opioids are potent painkillers. And that can be a blessing or a curse.

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If you’re in severe pain after surgery or an injury, opioids like morphine, fentanyl, hydrocodone or oxycodone are a godsend. But become dependent on them, and the consequences can be deadly.

“Unfortunately, anyone can develop an opioid addiction — even those who’ve never been addicted to anything in the past,” warns pharmacist Elizabeth Casserly, PharmD, RPh, BCPS. She specializes in pain management.

Opioids are typically safe when taken on their own and in low doses, she notes. But when you’re taking several opioids at once, or taking them in high doses, the risk of overdose and death spikes.

A growing problem

“With the aging of our population, people need more and more medication for chronic conditions and for sleep problems. This has helped to fuel the opioid epidemic,” Dr. Casserly notes.

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For example, when taking these common medications with opioids, their potency multiplies:

  • Benzodiazepines. Xanax®, Klonopin®, Valium® and Ativan® are commonly prescribed for anxiety. But, like opioids, they also reduce your respiratory rate and can be addictive.
  • Sleep aids. Ambien® and Lunesta® are popular remedies when you’re struggling with poor sleep. But because they decrease your respiratory rate, they’re not safe to take with opioids.
  • Muscle relaxants. Medications like Soma® may be prescribed for muscle pain. But they’re unsafe to use with opioids because they can also cause increased sleepiness and reduce your respiratory drive.

“Physicians don’t knowingly prescribe such drugs together,” says Dr. Casserly. “It happens inadvertently. For example, a patient may fill a benzodiazepine prescription from their primary doctor. Then, maybe months later, they’ll fill an opioid prescription from their pain doctor.”

Why opioids are the go-to pain drug

Other pain medications are less addictive and cause fewer interactions. So why have opioids become so popular?

“They’re like a shotgun, instead of a rifle — they have a broad effect on many types of pain,” explains Dr. Casserly.

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In contrast, other medications help only with specific types of pain. “For example, medication for nerve pain won’t work for inflammatory pain, and vice versa,” she says.

Alternatives to opioids

Because of potentially deadly interactions, physicians are encouraged to prescribe opioids only as a last resort. So Dr. Casserly often suggests alternatives for the three major types of pain:

  • Nerve pain. Surprisingly, the tricyclic antidepressants (amitriptyline, nortriptyline, desipramine) also help relieve to nerve pain. Serotonin-norepinephrine reuptake inhibitors (duloxetine), also prescribed for depression, help with physical pain as well. The same is true for anticonvulsants such as gabapentin and pregabalin. “Neuropathy can be difficult to treat. It can take weeks for patients to feel the full benefit of many of the medications,” says Dr. Casserly. “In the meantime, lidocaine cream or patches can offer short-term relief.”
  • Inflammatory pain. You’ll find nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen at the drugstore. Or your doctor may prescribe NSAIDs such as diclofenac or meloxicam. All NSAIDs dull the pain of inflammation from arthritis. But you’re at risk of NSAID complications if you have cardiovascular disease, kidney disease or gastrointestinal bleeding, she cautions.
  • Musculoskeletal pain. Heat, stretching and physical therapy are effective alternatives for musculoskeletal pain. “Sometimes, muscle relaxants can be used for the short term,” Dr. Casserly adds.

Worried about drug interactions?

Talk to your doctor’s office or neighborhood pharmacist if you’re concerned that a painkiller may interact with your other medications. “Your pharmacist can work with your physician to problem-solve and explore alternatives,” says Dr. Casserly.

But be sure to talk to your physician if you’re worried about how you or someone you love is taking pain medication, as that may be a sign of addiction.

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