Why We Love Opiates

Neurological effects of hydrocodone.

By Kevin RR Williams

HEALTH Experiencing whiplash following an automobile accident, the urgent care physician offered a choice between codeine, hydrocodone or oxycodone. Doctors can quickly prescribe an opiate remedy for pain and get to the next patient. Whiplash? Back pain? Broken bone? Opiates are very effective at controlling pain, and relatively cheap.

Vicodin is a combination of hydrocodone (5, 10 or 15 mg) and acetaminophen (325 mg). Its three “flavors” are often prescribed to treat moderate to severe pain. In a clinical study, Percocet, a combination of oxycodone and acetaminophen, is 1.5 times more potent than Vicodin (5 mg). Percocet is prescribed to treat moderate to severe pain. Both of these products are opiates with similar side effects. These are some of the common opiates and their generic names. Here is an incomplete list of opiates in order of increasing strength.

  1. Codeine
  2. Vicodin, Norco, Hycodan, Lortab, Lorcet (hydrocodone)
  3. MS Contin, Kadian, Avinza (morphine)
  4. Oxycontin, Percoset, Percodan, Roxicodone (oxycodone)
  5. Dilaudid (hydromorphone)
  6. Duragesic (fentanyl)

Why We Love Opiates

Short-term effects of hydrocodone are that it can modify pain signaling in the central nervous system. It does not decrease the source of the pain but changes the perception of pain. Hydrocodone increases the amount of pleasure-producing dopamine in the brain.

So when your employment sick days are limited, you need to conduct a class, to deliver a presentation before a group of people or do anything other than lie in bed with excruciating pain, euphoric opiates can be quite appealing. But they can be addictive and cause many health problems.

Symptoms of Overdose

If any of the following symptoms of overdose occur while taking hydrocodone, get emergency help immediately:

  • Blue lips and fingernails
  • Blurred vision
  • Change in consciousness
  • Chest pain or discomfort
  • Cold and clammy skin
  • Confusion
  • Constricted pupil (black part of the eye)
  • Coughing that sometimes produces a pink frothy sputum
  • Decreased awareness or responsiveness
  • Dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • Increased sweating
  • Irregular, fast or slow, or shallow breathing
  • Lightheadedness, dizziness, or fainting
  • Pale skin
  • Sleepiness or unusual drowsiness
  • Slow or irregular heartbeat
  • Weak muscle tone

Minor Side Effects

Some of the side effects may not need medical attention. As your body adjusts to hydrocodone during treatment, these sensations may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

More common:

  • Constipation
  • Nausea

Less common:

  • Abdominal or stomach pain or discomfort
  • Back pain
  • Bladder pain
  • Bloody or cloudy urine
  • Difficult, burning, or painful urination
  • Dry mouth
  • Frequent urge to urinate
  • Heartburn
  • Itching skin
  • Lower back or side pain
  • Muscle spasms
  • Vomiting

The most commonly reported side effects included constipation, nausea, vomiting, fatigue, upper respiratory tract infection, dizziness, headache, and somnolence.

The Centers for Disease Control & Prevention (CDC) recently released the first federal opioid prescription guidelines. “The goal is to help physicians prescribe opioids in a rational fashion,” pain management specialist Richard Rosenquist, MD at Cleveland Health Clinic. An article in the Journal of the American Medical Association on the guidelines says more than 165,000 people died from opioid overdoses between 1999 and 2014. The CDC guidelines include suggestions such as:

  • Look for non-opioid therapy options first.
  • Talk to you about the risks and benefits of controlling pain with opioids.
  • Start your therapy with the lowest dose necessary, and increase the dose slowly — and only if needed.
  • Limit your opioid therapy for acute pain to less than three days. Prescribing opioids for more than seven days should typically be rare.

Naproxen (Aleve) is a drug that works slower than ibuprofen (Advil), but in the end will offer longer-term relief compared to the short-term benefit of ibuprofen. Furthermore, it is much better at targeting muscle tissue inflammations, pain that could be caused by a sprain, arthritis, or strained muscles. —Curiosity Aroused

UCLA Health has implemented a program to reduce opiate prescriptions for back pain. Their research indicates 70 to 90 percent of back pain sufferers improve within seven weeks with conservative treatment — rest in appropriate positions, over-the-counter pain relievers (ie. Advil, Aleve), etc. Ten days of such treatment is followed by physical therapy. At the six-to-eight-week point from the initial appointment, if the patient still is in significant pain, MRI and x-ray imaging with the option of physical rehabilitation or pain management is introduced.

Advil versus Aleve comparison chart

Advil Aleve
Dosage 200-800 mg per dose 220 mg (OTC dosage)
Forms Advil is available in the form of tablets, chewable tablets, capsules, gelcaps, suspensions and oral drops. Aleve is available in tablets, caplets, liquid gels and gelcaps.
Active ingredient Ibuprofen Naproxen
Side effects Nausea, dizziness, gastro­intestinal bleeding Higher incidence of photo­sensitivity and digestive tract problems.
Brand owner Pfizer (formerly Wyeth) Bayer
Action mechanism Acts by inhibiting cyclooxy­genases (COX-1 and COX-2) Acts by inhibiting cyclooxy­genases (COX-1 and COX-2)
FDA approval 1974 1991
Benefits Relief from body ache (including arthritis), fever reduction, anti clotting Relief from body ache (including arthritis), fever reduction, anti clotting.
OTC Yes Yes

Do you suffer from chronic pain? Do you agree that opiates are over-prescribed? What are your thoughts on alternatives to opiates? Is the UCLA Health approach too conservative? Do you regularly take OTC or prescription medications?

Tags: drug addiction, neurology, aleve vs. advil

References
  1. Vicodin vs. Percocet for Pain Reduction. healthline.com
  2. Opiates (Narcotics): Addiction, Withdrawal and Recovery. addictionsandrecovery.org
  3. The Effects of Hydrocodone Use. drugabuse.com
  4. Opiate Pain Relievers for Chronic Pain. webmd.com
  5. Hydrocodone Side Effects. drugs.com
  6. UCLA Health Vital Signs Addressing Back Pain. Winter 2017, pp. 8-9
  7. Beyond Opioids: New Guidelines Offer Safest Ways to Control Pain. clevelandclinic.org
  8. Aleve vs. Advil. diffen.com
  9. Commonly Abused Prescription and OTC Drugs. webmd.com