Narcotic Pain Medication Side Effects, Addiction, Withdrawal Symptoms, and Uses

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  • Medical and Pharmacy Editor: Jay W. Marks, MD
    Jay W. Marks, MD

    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

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    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

What are narcotic pain medications (opioids, analgesics)?

Narcotic medications are used for treating moderate to severe pain.

Narcotic pain medications attach to receptors on nerves in the brain that increase the threshold to pain (i.e., the amount of stimulation it takes to feel pain), and reduce the perception of pain (the perceived importance of the pain). Most men and women take narcotic pain medication for short-periods until the pain lessens or goes away. Some adults have chronic pain, which requires proper pain management since long term use can lead to drug addiction and tolerance (the need for increasing doses). Narcotic pain medication have a high potential for misuse, abuse, and diversion to supsceptible.

The CDC has recently developed and published the CDC Guideline for Prescribing Opioids for Chronic Pain to provide recommendations for the prescribing of opioid pain medication for patients 18 and older in primary care settings in 2016.

What are the side effects of pain medications?

Common side effects of narcotic analgesics include:

Severe side effects of narcotic analgesics include:

Are pain medications addictive?

Prescription narcotics are the most commonly abused opioids and the leading cause of opioid-related overdose in the U.S. Taking any opioid - even prescription opioids - for long periods can result in dependence, which means if you suddenly stop taking the drug you will have withdrawal symptoms. A small percentage of people taking narcotics will become addicted. Addiction is a chronic disease characterized by:

  1. Overpowering cravings, with compulsive drug use.
  2. The inability to control drug use, and continue to use them despite harm to the self or others.

Opioid addiction can result in an increased chance of :

  1. Death
  2. Overdose
  3. Infections
  4. Serious heart infections (endocarditis)
  5. Narcotic bowel syndrome

What are the withdrawal symptoms of addiction to pain medications?

Signs and symptoms of opioid withdrawal include:

  1. Abdominal cramps
  2. Diarrhea
  3. Nausea/vomiting
  4. Flu-like symptoms (fever, sweating, shivering, runny nose)
  5. Goosebumps (piloerection)
  6. Dilated pupils
  7. High blood pressure (hypertension)
  8. Fast heart rate
  9. Anxiety
  10. Irritability
  11. Sleep problems (insomnia)
  12. Agitation
  13. Restlessness
  14. Restless leg syndrome (RLS)
  15. Tremors (shaking)
  16. Yawning
  17. Loss of appetite
  18. Dizziness
  19. Joint or muscle pain
  20. Leg cramps
  21. Itching
  22. Seizures

Which drugs and supplements interact with pain medications?

Narcotic pain medications should not be used monoamine oxidase inhibitors (MAOIs) because of severe reactions that can be fatal.

  • phenelzine (Nardil)
  • selegiline (Zelapar, Emsam, and Eldepryl)
  • tranylcypromine (Parnate)
  • procarbazine (Matulane)
  • rasagiline (Azilect)
  • isocarboxazid (Marplan)

The discontinuation and initiation of narcotics and MAO inhibitors should be separated by at least 14 days.

Narcotics should be used with caution with these central nervous system depressants because of an increased risk of respiratory depression, low blood pressure, sedation, and in severe cases, coma and death.

  • alprazolam (Xanax)
  • clonazepam (Klonopin)
  • diazepam (Valium)
  • zolpidem (Ambien)
  • zaleplon (Sonata) and alcohol because of increased risks of respiratory depression,
  • Low blood pressure
  • Sedation
  • In severe cases, coma and death

Narcotic pain medications should be used with caution with medications that alter liver enzymes that affect the elimination of narcotic analgesics because levels of narcotic analgesics can increase or decrease in the body and thereby affect their therapeutic effectiveness.

Naloxone (Narcan) is a medication used to reverse the effects of narcotics, especially in acute overdose situations. In some states, Narcan is available via a prescription to the public for use in high-risk situations (such as having a close family member with a recent history of narcotic addiction or overdose).

Can I take pain medications if I'm pregnant or breastfeeding?

There are no adequate studies of narcotic pain drugs to determine if their use is safe and effective during pregnant women. Narcotic analgesics may pass through breast milk and affect the baby they should be avoided in females who are breastfeeding.

List of examples narcotic pain medication brand names available in the US

Examples of narcotic analgesics are:

Where can I get help and support for pain medication addiction?

Narcotics Anonymous World Wide Services is a global community based organization with a multicultural membership.

What forms of pain medications are available?

Pain medications are available as:

  • codeine
  • oxycodone
  • hydromorphone
  • methadone as immediate-release tablets
  • oxycodone and morphine extended-release tablets.
  • morphine and hydrocodone are available as extended-release capsules.
  • morphine as intravenous, subcutaneous, and intramuscular injections
  • fentanyl oral lozenge (Actiq) and topical patch (Duragesic)

Summary

Narcotic analgesics (also called opioids) are medications prescribed to treat moderate to severe pain. Examples (list) include codeine, hydrocodone, oxycodone (OxyContin Roxicodone, Oxecta, Oxaydo, Xtampza ER, and Roxy bond), methadone (Dolophine; Methadone HCl Intensol; Methadose; Methadose Sugar-Free), morphine (Morphine ER, morphine injection (Astramorph, Duramorph, Infumorph, and Avinza), hydromorphone (Dilaudid, Dialudid-5, and Exalgo), fentanyl (Sublimaze, Actiq, Duragesic, and Fentora).

Side effects of narcotics include dry mouth, itching, addiction, headache, dizziness, constipation, and nausea. Drug interactions, dosing, and pregnancy and breastfeeding safety information are provided.

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References
Centers for Disease Control. CDC Guideline for Prescribing Opioids for Chronic Pain. 29 August 2017. 9 November 2018 . Eric Strain, MD. Opioid use disorder: Epidemiology, pharmacology, clinical manifestations, course, screening, assessment, and diagnosis. 13 September 2018. 9 November 2018 . Kevin Sevarino, MD, PhD. Opioid withdrawal in adults: Clinical manifestations, course, assessment, and diagnosis. 10 April 2017. 9 November 2018 . REFERENCES:

CDC Guideline for Prescribing Opioids for Chronic Pain. CDC. Updated: Aug 29, 2017.
https://www.cdc.gov/drugoverdose/prescribing/guideline.html>

FDA Prescribing Information

Eric Strain, MD. Opioid use disorder: Epidemiology, pharmacology, clinical manifestations, course, screening, assessment, and diagnosis. 13 September 2018.
<https://www.uptodate.com/contents/opioid-use-disorder-epidemiology-pharmacology-clinical-manifestations-course-screening-assessment-and-diagnosis?search=opioid%20addiction&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=>

Kevin Sevarino, MD, PhD. Opioid withdrawal in adults: Clinical manifestations, course, assessment, and diagnosis. Updated: April 2017.
<https://www.uptodate.com/contents/opioid-withdrawal-in-adults-clinical-manifestations-course-assessment-and-diagnosis?search=opioid%20withdrawal&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2>
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