About prescription opioids

Opioids are prescription painkillers, but not all painkillers are opioids — for example, ibuprofen (Advil) and acetaminophen (Tylenol) are not opioids. Doctors, nurse practitioners and dentists prescribe opioids to treat moderate to severe pain.

Some commonly prescribed opioids include:

  • codeine (for example, Tylenol #3)
  • morphine
  • oxycodone (for example, Percocet, Endocet)
  • hydromorphone (for example, Dilaudid)
  • fentanyl (in patches only)

Opioid medications should not always be your first choice for treatment because they pose serious health risks. These include:

Talk to your health care provider (doctor, nurse practitioner, dentist or pharmacist) about other treatments for pain that do not involve opioid medications.

Acute versus chronic pain

Pain can be short-term (acute) or long-term (chronic). Unlike the short-term pain you might feel after an injury or during a brief illness, chronic pain can last for months or even years. Each person is the best judge of their own pain.

Acute pain

Acute pain usually comes on suddenly but is expected to go away on its own after normal healing. Examples include:

  • injuries
  • surgery
  • dental work
  • burns or cuts
  • labour and childbirth

Chronic pain

Chronic pain usually lasts longer than three months, or longer than expected healing time, and is linked to ongoing conditions. These may include:

  • nerve or spinal cord damage
  • arthritis
  • fibromyalgia
  • cancer

Treatment options for pain management

Opioid medications should not always be your first option for pain management. Your health care provider should talk to you about different combinations of therapies and/or non-opioid medications before discussing opioids with you.

Options for acute pain

  1. Physical treatments

    These include:

    • heat
    • ice
    • massage
    • stretching
    • rest
  2. Non-opioid medications

    Including prescription and over-the-counter medications, such as:

    • Acetaminophen (Tylenol)
    • nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil) and naproxen (Aleve)
  3. Physical activity and exercise

Options for chronic pain

  1. Non-opioid medications

    Including prescription and over-the-counter medications, such as:

    • Acetaminophen (Tylenol)
    • nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil) and naproxen (Aleve)
    • anti-seizure medications, such as gabapentin and pregabalin
    • antidepressants, such as amitriptyline
  2. Physical activity and exercise

  3. Psychological therapies

    These include:

    • cognitive behavioural therapy
    • guided imagery
    • other relaxation techniques
  4. Chronic pain clinic

Starting and stopping prescription opioids

Before starting opioids

If you’re thinking about taking prescription opioids for pain, speak to your health care provider. They can:

  • explain the potential benefits and harms of opioid medications so you can make decisions about your care together, including side effects, addiction and overdose
  • review your other medications to see if you are taking any that are dangerous to combine with opioids, such as benzodiazepines like Ativan or Valium
  • discuss whether you use alcohol and other drugs
  • discuss any mental health conditions you might have

Starting opioids

If you and your health care provider decide treatment with opioids is right for you, your health care provider should:

  • prescribe the lowest dose and lowest strength that will work for you (usually three days or less for acute pain, and not more than seven days for more severe pain that might occur after major surgery)
  • monitor your pain and help you to stop taking opioids if they were prescribed for short-term use
  • explain how to safely store your medication and safely dispose of any unused medication you no longer need

Stopping opioids

If appropriate, talk to your health care provider to make a plan together to help you cut down or stop taking opioids safely. If you cut down or stop too quickly, you may experience uncomfortable physical symptoms such as:

  • anxiety
  • trouble sleeping
  • muscle aches
  • diarrhea
  • upset stomach
  • vomiting

Your health care provider should talk with you about cutting down or stopping your opioid medication when 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 three months or longer

When you are cutting down, you might find it helpful to try other ways to manage your pain, like physical activity, psychological therapies, or cultural and spiritual practices.

Side effects, addiction and overdose

Side effects

Over time, the body gets used to opioids and they stop working as well. To get the same relief, you may need to take more and more. This is called “tolerance.” Higher doses can cause serious side effects like:

  • nausea
  • vomiting
  • itching
  • constipation
  • not being able to urinate (empty your bladder)
  • slowed breathing, which can be deadly
  • confusion and changes in mental state

Addiction

Opioids carry risk of addiction.

Signs you might be addicted to prescription opioids include:

  • running out of prescription medications early
  • getting your prescription from many sources (for example, multiple health care providers and pharmacies)
  • using someone else’s medications
  • failing to fulfil responsibilities at work, school or home
  • giving up activities that were once enjoyable

If you think you are addicted to prescription opioids, or at risk of becoming addicted, get help through:

Overdose

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

Storing medications safely

Store your opioid medication in a secure place out of reach and out of sight of:

  • children
  • teens
  • pets
  • visitors

Do not share your prescription opioids with friends or family even if you have benefited from the medication. They have been prescribed by your health care provider for your condition only and are not meant to be taken by anyone else.

Disposing medications safely

Do not leave expired and unused prescription opioids in medicine cabinets or cupboards — this can lead to potential misuse and abuse.

Do not flush medicines down the toilet or sink.

To dispose of prescription opioids safely, you can either bring them to:

  • your local pharmacist
  • a take-back program offered by your local police service

In the garbage

It’s not recommended to throw your medications in the garbage. But if you have to, make sure to:

  • remove medications from their original containers
  • remove all identifying information on the prescription label to protect your privacy
  • hide the medications in something unappealing, such as used coffee grounds or kitty litter — this will make them less attractive to pets and people
  • place them in a closed bag, empty can or other sealed container to prevent the drug from leaking or breaking out of a garbage bag
Updated: September 23, 2021
Published: January 14, 2019