Safe Opioid Use: What You Need to Know

This information explains what opioids are and how to take them safely.

What are opioids?

Opioids are strong painkillers prescribed to help with moderate to severe pain. They’re also called narcotics. While opioids come with some risks, they can help you manage your pain. It’s important to follow your healthcare provider’s instructions and the tips in this resource when taking opioids.

You may be prescribed opioids when other medications don’t help with your pain or affect your cancer treatment. Opioids can help you manage your pain so you can do your daily activities and improve your quality of life.

Some commonly prescribed opioids are:

• Hydrocodone (Vicodin®)
• Oxycodone (Percocet, Oxycontin®)
• Tapentadol (Nucynta®)
• Hydromorphone (Dilaudid®)
• Morphine (Duramorph)
• Fentanyl patch (Duragesic)
• Buprenorphine
• Codeine (Codeine Sulfate)
• Tramadol (Ultram®)
• Methadone (Dolophine®)
• Meperidine (Demerol®)

What is the opioid epidemic?

The opioid epidemic refers to the increase in opioid addiction (a strong urge to use a substance) and opioid-related deaths. This is caused by opioid misuse. Opioid misuse is when you:

• Take your opioids differently than how your healthcare provider prescribes.
• Take someone else’s opioids.
• Take opioids when you don’t need them.

You can safely manage your pain with opioids by following your healthcare provider’s instructions.

How can I take opioids safely?

You can take opioids safely by following these tips.

• Take them as prescribed. Follow your healthcare provider’s instructions when taking opioids. Don’t take more opioids than your healthcare provider told you to take.
• Make a list of all your medications. This list should include all opioids, other medications, and dietary supplements (such as herbs, vitamins, or home remedies) that you’re taking. Write down the names, dose amounts, and how often you take them. Bring this list with you to all your appointments so your care team can safely manage your medications.
• Don’t drive while taking opioids. Opioids can make you drowsy and less alert, which can cause an accident.
• Avoid drinking alcohol and using recreational drugs while taking opioids. Using alcohol and recreational drugs while taking opioids can have serious side effects, such as trouble breathing.
• Store opioids safely. Keep your opioids in a safe place, such as in a locked cabinet. Make sure they are stored away from others, including visitors, children, friends, family, and pets.
• If you don’t need them, don’t keep them. Get rid of your unused or expired opioids when you don’t need them anymore. This can help you make sure you don’t take more than you need. It also lowers the chances that someone else might take them. For more information, read the section called “How can I get rid of my unused opioids?”
• Only take opioids prescribed to you. Don’t share your opioids with another person or take another person’s opioids.
• Talk to your healthcare provider about changing your dose. Stopping opioids suddenly can cause you to have side effects from medication withdrawal. This doesn’t mean you’re addicted. It’s a normal reaction when you stop taking medication too quickly. If you want to increase, decrease, or stop taking opioids, ask your healthcare provider how to do it safely.
• Make sure you have naloxone (Narcan®). If you’re prescribed opioids, we will also prescribe you naloxone (Narcan). This is an emergency medication that can reverse or block an opioid overdose if you take more opioids than we prescribe you. For more information, read About Naloxone (Narcan®).
  • Always call 911 after using naloxone. Its effects only last 30 to 90 minutes, and you may need more medical care.
  • If you’re unsure if you should use naloxone, call 911, and follow the operator’s instructions.

If you have trouble breathing or become unconscious, someone must call 911 right away.

What are common side effects of taking opioids?

You may have side effects while taking opioids. The following are common side effects, but there can be others. Talk with your healthcare provider if you have any concerns about side effects.

Opioids can cause:

• Constipation (having fewer bowel movements than usual). For more information about how to manage constipation, read Managing Constipation.
• Nausea (feeling like you will throw up) or vomiting (throwing up). This usually gets better in a few days.
• Sleepiness that gets in the way of your daily life. If this doesn’t get better in 3 to 5 days, call your healthcare provider.

Why might side effects be greater for older adults?

• Older adults usually have more than 1 medical condition they take medication for. This increases their chances of having side effects from the different medications.
• If you take opioids, you may feel drowsy and have a greater risk of falling. Falling can be even more dangerous for older adults. Older adults should be careful while taking opioids. They may need to use something to help them stay balanced, such as a cane. For more information, read What You Can Do to Avoid Falling.
• Memory loss can be present in older adults. For people with memory loss, taking opioids may lead to:
  • Increased confusion.
  • Sleepiness.
  • Hallucinations (sight, sound, smell, taste, or touch that a person believes to be real, but it’s not).

If you have any of these side effects, talk with your healthcare provider.

How will I know if I’m getting addicted to opioids?

Addiction feels like an uncontrollable urge to take opioids, even without having pain.

Talk to your healthcare provider if you think you may be at risk for addiction. Some common risk factors for addiction include:

• Having a personal or family history of substance abuse.
• Being 45 years of age or younger.
• Depression (having strong feelings of sadness).
• Anxiety (having strong feelings of worry or fear).

While addiction in people with cancer-related pain is rare, it’s possible.

Where can I go for help?

If you’re concerned about getting addicted or have questions about taking opioids, talk with your care team. This includes your doctors, nurses, advanced practice providers (APPs), and social workers. They can help you get the care you need.

At MSK, we talk with everyone about their risk for opioid misuse. People who need treatment for opioid misuse can get the support they need at MSK or at other treatment centers. For more information, visit the websites below.

Center for Disease Control (CDC)
www.cdc.gov/opioids
Visit the CDC’s website to learn more about opioids.

Substance Abuse and Mental Health Services Administration (SAMHSA)
800-662-HELP (800-662-4357)
www.samhsa.gov/find-help/national-helpline
SAMHSA’s National Helpline is a free, confidential referral and information phone service. It’s for people facing mental or substance use disorders and their families. The Helpline is open 24 hours a day, 7 days a week, and is available in English and Spanish. Call them or visit their website for more information.

How can I get rid of my unused opioids?

It’s important to get rid of your unused or expired opioids when you don’t need them anymore. This helps make sure you don’t take more opioids than you need and keeps others taking them.

To get rid of your opioids safely, use one of these options:

• Find out about prescription drug take-back events from:
  • Your local pharmacy.
  • Your local recycling coordinator that is in charge of recycling programs.
  • Your city or town government office.
  • The U.S. Drug Enforcement Administration’s (DEA’s) Take Back Day website (www.dea.gov/takebackday).

• Find a controlled substance public disposal location near you by using the Drug Enforcement Administration Diversion Control Division’s website (bit.ly/2TGiC86) or call 800-882-9539.
• Some opioids can also be flushed down the toilet. To see if your medication should be flushed, visit the U.S. Food and Drug Administration’s (FDA’s) flush list (bit.ly/2VigSCB).
• Bring your unused or expired opioids to MSK’s drop off location at:

425 East 67^th Street (between York and First avenues)
Haupt Pavilion, Room A105
New York, NY 10065

For more information, read How to Get Rid of Your Unused Medications.

What are other ways I can manage my cancer pain?

Talk to your care team about other ways to manage your cancer pain that don’t include opioids. Some of these options may work better for you and have fewer risks and side effects. Other options may include:

• Taking other types of pain medication. They include over-the-counter medication, such as acetaminophen (Tylenol®), ibuprofen (Advil®), or naproxen (Aleve®), or other non-opioid prescription medications. Remember to talk with your healthcare team about what medications you’re taking, even if they are over-the-counter.
• Having a nerve block procedure. This stop your nerves from sending pain messages to your brain.

• Scheduling an appointment with the Integrative Medicine Service. Integrative medicine therapies combine natural treatments, such as acupuncture, massage, and yoga, with your overall cancer pain management plan. For more information, read Integrative Medicine Therapies and Your Cancer Treatment or call 646-449-1010.
• Physical therapy and exercise. Ask your healthcare provider if physical therapy and exercise can help you manage your cancer pain.