Opioids and painkillers
Know the risks and learn how to properly use prescription and non-prescription painkillers to manage pain.
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If you are with someone who has overdosed, call 911 immediately.
Don’t let legal fears stop you from getting help. The Good Samaritan Drug Overdose Act provides some legal protection if you experience or witness an overdoes and call 911 for help.
Medications that relieve pain are known as painkillers. Opioids are strong painkillers that you need a prescription for.
Doctors, nurse practitioners and dentists prescribe opioids to treat moderate to severe pain. If your health care provider prescribes you pain medication, take the medication exactly as prescribed.
Opioids that are often prescribed are:
- codeine (for example, Tylenol #3)
- oxycodone (for example, Percocet, Endocet)
- hydromorphone (for example, Dilaudid)
- fentanyl (in patches only)
[Aside: Not all painkillers are opioids. For example, ibuprofen (Advil) and acetaminophen (Tylenol) are not considered opioids.]
Street drugs are substances produced or obtained illegally. They can come in different strengths and qualities. This is especially risky for more powerful street opioids like fentanyl and carfentanil, as well as newer synthetic opioids that can be up to 20 times stronger than fentanyl.
Fentanyl and carfentanil cannot be seen, smelled or tasted. There is no way to know if they’ve been added to another drug and you should not assume your dealer knows. Dealers can unknowingly contaminate other drugs if they’ve also handled fentanyl or carfentanil.
Street drugs may also contain substances such as depressants, stimulants, psychoactive drugs, or fillers used to increase their volume (including starches, sugars and medications that can be toxic). These added substances can lead to harm by changing overdose symptoms and reacting differently to overdose responses.
Public health units send out alerts when potentially toxic drugs or drugs containing unexpected substances, which can lead to more cases of drug poisonings, are found in the local community.
Opioids can cause physical and psychological (mental) dependence.
Opioid medications should not be your first choice for pain treatment because they have serious health risks.
Over time, the body can develop a tolerance to opioids, making them less effective. To get the same relief, you may need to increase the amount you take.
Taking higher doses can lead to serious side effects, such as:
- not being able to urinate
- slowed breathing
- changes in mental state
Opioids carry risk of dependance.
These are signs that you might be misusing opioids or that its use may be negatively affecting your health:
- running out of prescription medications early
- getting your prescription from many sources
- using someone else’s medications
- failing to fulfil responsibilities at work, school or home
- giving up activities that were once enjoyable
- experiencing cravings
- physical dependence and withdrawal symptoms, such as:
- feeling agitated
- abnormal yawning
- increased tolerance
- extended usage after prescribed time
- spending time and effort getting, using and recovering from opioids
- continuing to use opioids despite experiencing harmful effects
You are at risk of an opioid overdose if you:
- are using street drugs
- are taking more than your prescribed dose of opioids
- are taking prescription opioids that were not prescribed to you and could be too strong for you
- are mixing your opioids with alcohol or anxiety medications (for example, Valium, Xanax)
- have overdosed on opioids before
- have stopped using opioids for a while, which has lowered your tolerance
What to do if someone overdoses
Call 911 for help.
If available, use naloxone to reverse the effects. Get a free naloxone kit.
Even if you reverse an overdose using naloxone, you should still call 911 for help.
A person can overdose again when the naloxone wears off, even if they haven’t used more drugs, because the drug may still be in their system.
Don’t let legal fears stop you from getting help. The Good Samaritan Drug Overdose Act provides some legal protection if you experience or witness an overdose and call 911 for help.
Using opioids, especially those obtained without a prescription, increases the chance of accidental poisoning (overdose), which can be fatal.
Starting and stopping prescription opioids
This information is intended to reduce the harms related to drug use, including death.
Talk to your health care provider
Consult with a health care provider, your local public health unit about your medical history for personalized advice on managing pain.
They can decide if it’s safe for you to start or stop the use of prescription painkillers, based on the reason for your pain.
Additional health care provider support
Before starting opioids
If you or someone you know is thinking about using opioids for pain management, consult with a health care provider who can:
- explain the potential benefits and harms of opioid medications
- check if any medications you’re taking could be harmful if combined with opioids (such as benzodiazepines, like Ativan or Valium)
- discuss the harms of mixing alcohol and other drugs with opioids
- discuss any mental health concerns
If you and your health care provider decide pain management treatment with opioids is right for you, your provider should:
- prescribe the lowest strength and dose to effectively relieve your pain
- usually, 3 days or less for acute pain
- usually, no more than 7 days for more severe pain, such as after major surgery
- monitor your pain and help you to reduce or stop the use of opioids, specifically if they were prescribed for short-term use
- explain how to safely store your medication and safely dispose of any unused medication
If you cut down or stop too quickly, you may experience uncomfortable physical symptoms such as:
- trouble sleeping
- muscle aches
- upset stomach
If appropriate, discuss with your health care provider about creating a plan for safely reducing or stopping the use of opioids. Talk with them about cutting down or stopping opioid medication if you:
- want to cut down or stop taking opioids
- are having problematic side effects
- feel your pain is not getting better
- are on a very high dose of opioids
- have been taking opioids for 3 months or longer
Reduce your risk
Find a consumption and treatment services (CTS) site near you. These sites offer supervised drug consumption and overdose prevention services.
Naloxone is a drug that can temporarily reverse an opioid overdose.
Free kits can be picked up anonymously at eligible pharmacies and community organizations . You are eligible for a free naloxone kit if you are:
- at risk of an opioid overdose
- a family member, friend, or other person able to help someone at risk of an opioid overdose
- a client of a needle exchange program, hepatitis C program or consumption and treatment service
- being released from a correctional facility
If you or someone you know is using opioids, it is important to know:
- where to get a free naloxone kit
- how to recognize and respond to an opioid overdose
- how to use a naloxone kit
- if you must have a naloxone kit at your workplace
ConnexOntario helps you find free, confidential and local health services for people experiencing problems with alcohol, drugs, mental illness or gambling. You do not need an appointment or referral.
This service is available 24 hours a day, 7 days a week.
Their services include:
- providing contact information for mental health and dependence services and supports
- listening, offering support and providing strategies to help people meet their needs
- providing basic education about drugs, alcohol, gambling or mental health
If you need help finding a doctor, nurse practitioner or other health care provider, visit Health811 online or call 811. This service is available 24 hours a day, 7 days a week.
Health811 connects you with support for health care questions and helps you find services like community health centers, mental health support or walk-in clinics.
Chronic pain clinics
If chronic pain plays a role in your opioid use, you may be a candidate for a referral to a chronic pain clinic.
Talk to your doctor or nurse practitioner to determine if this would be a good option for you.
Store and dispose opioids safely
Consider locking up prescription medications to prevent potential misuse and keep them out of reach for children, youth and other adults in your home.
Avoid leaving expired or unused prescriptions in cabinets or cupboards. Do not flush prescription opioids down the toilet or sink.
For safe disposal, bring them to a:
- local pharmacist
- take-back program offered by your local police service
Do not share your prescription opioids with friends or family even if you have benefited from the medication. Your medication is prescribed by your health care provider for your condition only and is not meant to be taken by anyone else.
Disposing of prescription medications in the garbage is not recommended. If you must, throw out your prescription, make sure you:
- remove medications from their original containers
- remove all identifying information on the prescription label to protect your privacy
- conceal the medications in something unappealing, such as used coffee grounds or kitty litter, to make them less attractive to pets and people
- place them in a sealed bag, empty can or another closed container to prevent the medications from leaking or breaking free from the garbage bag
Alternatives for pain management
Pain can be either short-term (acute) or long-term (chronic). Short-term pain might occur after an injury or during a brief illness, while long-term pain can last for several months or even years.
Opioids medications should not be your first choice for pain management. Before considering opioid treatment, your health care provider should talk to you about the different combinations of therapies and non-opioid medications.
Options for acute pain
Acute pain usually comes on suddenly and lasts less than 3 months but is expected to go away on its own after normal healing.
Non-opioid prescription and over-the-counter medications
- acetaminophen (Tylenol)
- nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil) and naproxen (Aleve)
- physical therapy
Options for chronic pain
Chronic pain usually lasts longer than 3 months, extending beyond the expected healing time and is typically linked to ongoing conditions, such as fibromyalgia, arthritis, nerve or spinal cord damage.
- Cognitive behavioural therapy
- Guided imagery
- Other relaxation techniques
- Support groups
- Individual and group psychotherapy
Non-opioid prescription and over-the-counter medications
- Acetaminophen (Tylenol)
- Nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil) and naproxen (Aleve)
- Anti-seizure medications, such as gabapentin and pregabalin
- Anti-depressants, such as amitriptyline
Physical activities and exercises
- Exercise, movement and physical activity
- Graded motor imagery
- Activity modification
- Graded activity participation and exposure
- Yoga and Tai Chi