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. Percocet is prescribed to treat more severe pain. Both of Percocet and Vicodin are opiates with similar side effects. Below are some of the common opiates with their generic names. Here is an incomplete list of opiates in order of increasing strength.

Opiate Pharmaceutical and Brand Names

  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 signals in the central nervous system. It does not eliminate the source of the discomfort but changes the body’s perception of pain. Hydrocodone also increases the amount of pleasure-producing dopamine in the brain.

Hydrocodone can be considered as less intense in its cognitive euphoria than morphine or diacetylmorphine (heroin) due to the upper limit of how much can be converted into its active form through metabolism. It is still, however, capable of extreme intensity and overwhelming bliss at heavier dosages with a low tolerance. The sensation itself can be described as a powerful and overwhelming feeling of emotional bliss, contentment, and happiness. It does not necessarily make pain pleasurable but it can make it tolerable while distracting it with cognitive euphoria.

So when your employment sick days are limited, you need to conduct a class, to deliver a presentation or do more than lie in bed with excruciating pain, euphoric opiates may be quite appealing. But they can have undesirable side effects, cause many health problems, and become addictive if taken frequently.

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 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, consult 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 patient about the risks and benefits of controlling pain with opioids.
  • Start therapy with the lowest dose necessary, and increase the dose slowly — and only if needed.
  • Limit 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 available in tablets, chewable tablets, capsules, gelcaps, suspensions, and oral drops. Aleve 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

Neurontin – or its generic form, gabapentin – is sometimes used for opiate withdrawal. Gapabentin helps to relieve pain by slowing down the pain signals that travel through the nerves. Affecting people different ways, Neurontin effects may start to fade for those who do benefit from higher dosages. One of Neurontin’s benefits is its ability to mimic opiate effects in the body. This means a person can stop taking opiates without suffering harsh withdrawal effects. While the addiction potential is low, someone coming off Neurontin or gabapentin may need to taper the dosage so brain and body chemical processes can learn to function normally without the drug’s effects.

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?

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Tags: aleve vs. advil, drug addiction, neurology, opioids

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