"Nobody is safe from this epidemic that threatens young and old, rich and poor, urban and rural communities. Everybody is threatened. Drug overdose is now the leading cause of accidental death in the United States, and opioid overdose deaths have nearly quadrupled since 1999. It is a problem the likes of which we have not seen."
~ President Donald Trump
Between 1994 and 2015, more than 185,000 Americans died because of prescription drug overdoses.
That's more than the population of Vancouver, Washington.
ALL opioid painkillers carry a risk of dependence, misuse, addiction, and overdose. This is why the Centers for Disease Control and Prevention, the Food and Drug Administration, and the US Surgeon General all issued new guidelines in 2016 concerning opioid prescribing.
But if doctors are now being told that powerful opioid painkillers should only be prescribed as "last resort", what do YOU know about the medications you are taking?
Let's take a look at some of the most dangerously addictive opioid pain medications on the market.
"We know of no other medications routinely used for a nonfatal condition that kills patients so frequently. We hope to see fewer deaths from opiates. That's the bottom line. These are really dangerous medications that carry the risk of addiction and death."
~Dr. Thomas Frieden, MD, Director of the CDC
To varying degrees based on potency, all opioids affect the body in similar ways. Besides the ability to block pain messages in the body, all opioids - even when taken as prescribed - have the following potential side-effects:
These last two side effects are the biggest reasons why opioids are misused non-medically - to get high and/or to avoid painful symptoms of opioid withdrawal. And that misuse leads to addiction.
And the stronger an opioid is, the faster it works, and the shorter the duration of its effects, the easier it is to become addicted.
Because of these factors, there are 5 types of commonly-prescribed opioids that are particularly dangerous. The mere fact that they are so available means a significant percentage of patients will abuse them.
Together, these six opioid classes account for over TWO HUNDRED MEDICATONS that could be given to you or your family.
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"Vicodin, I got addicted to that little pill. The reason I don't talk about it too much in the press is because it isn't funny, and I love to be funny in interviews. If you joke about that period in your life, it doesn't seem right."
Addiction Risk: Severe/High
Class: Semi-Synthetic, synthesized from codeine
Relative Strength: EQUAL to morphine
Onset of Action: 10-30 minutes
Duration: 4-6 hours
History: First synthesized in Germany in 1920, approved for sale in the US in 1943
Medical Uses: Hydrocodone medications are primarily prescribed to treat moderate-to-severe-pain, although it can also be given in liquid form as a cough suppressant.
Hydrocodone is found in the following medications:
Unique Side-Effects of Hydrocodone:
Notes about Hydrocodone:
99% of the world's hydrocodone is consumed in the United States.
“To defeat the epidemic, we must stop creating new users, and part of that is making sure these highly addictive and dangerous drugs are marketed truthfully and without deception and in such a way as not to minimize addiction risks or overstate benefits to patients.”
~New Hampshire Deputy Attorney General Ann Rice, in a lawsuit against Purdue Pharma, the makers of OxyContin
Addiction Risk: High
Class: Semi-Synthetic, synthesized from thebaine
Relative Strength: 1.5-2 times STRONGER than morphine
Onset of Action: 10-30 minutes, reaching peak effect in 30-60 minutes. Controlled-release oxycodone starts to relieve pain in about one hour, reaching its peak at about 3 hours.
Duration: 3-6 hours for instant-release oxycodone, 12 hours for controlled-release
History: First synthesized in Germany in 1916, introduced in the US in 1939
Medical Uses: Oxycodone medications are prescribed for moderate-to-severe acute or chronic pain. It is considered a first-line alternative option for cancer pain.
Unlike most other opioids, oxycodone can be prescribed for children as young as 11 as an alternative to fentanyl.
Although some countries allow intramuscular or intravenous oxycodone use, in the United States, only oral oxycodone use is approved. Oxycodone is found in the following medications:
Unique Side-Effects of Oxycodone:
Notes About Oxycodone:
OxyContin is the most-abused prescription opioid in America.
In 2007, Purdue Pharma – the manufacturer of OxyContin – was fined more than $600 million because the company’s sales representatives had intentionally misled both the public and doctors by misrepresenting OxyContin as less euphoric and less addictive than other opioids.
“Codeine addiction is something that is a bit of a hidden problem, unlike things like alcohol addiction or other drug addictions.”
~ Dr. David Outridge, Newcastle, New South Wales
Addiction Risk: High
Class: Natural, extracted from the opium poppy or synthesized from morphine
Relative Strength: 1/10th the strength of morphine
Onset of Action: 30 minutes, reaching peak effect in 2 hours
Duration: 4-6 hours
History: First identified in France in 1832
Medical Uses: Codeine medications are prescribed for mild-to-moderate pain and severe diarrhea, such as might be caused by Irritable Bowel Syndrome. Once considered the “gold standard” for cough suppression, newer studies suggest that it may, in fact, be no better than a placebo.
Codeine is found in the following medications:
Unique Side-Effects of Codeine:
Notes about Codeine:
Codeine is the most-used opioid in the world, and on the World Health Organization’s List of Essential Medicines.
Drinking excessive amounts of cough suppressant containing codeine – called “purple drank”, “lean”, or “syrup” – is the most-common method of abuse.
"She split two hydromorphone Dilaudid capsules. Her body just couldn't do it. She wasn't very big."
~ mother Dale Jollota, whose 15-year-old daughter died of acute hydromorphone intoxication while experimenting with drugs
Addiction Risk: Very High
Class: Semi-Synthetic, derived from morphine
Relative Strength: 4-8 times STRONGER than morphine
Onset of Action: 5 minutes intravenously, 30 minutes for oral instant-release formulations, reaching peak effect at 30-60 minutes
Duration: 2-3 hours
History: First synthesized in Germany in 1924
Medical Uses: Hydromorphone is prescribed for the treatment of moderate-to-severe acute or chronic pain. In some formulations, it is used to as a cough suppressant. In a nebulizer, it can treat shortness of breath.
Medications that include hydromorphone include:
Unique Side-Effects of Hydromorphone:
Notes about Hydromorphone:
Interestingly – or perhaps tellingly – hydromorphone is used as a backup execution drug in Ohio and Arizona.
"They never should have allowed Opana back on the market. We never needed it. We had plenty of opioid options."
~Andrew Kolodny, Codirector of the Opioid Policy Research Collaborative, Brandeis University
Addiction Risk: High
Class: Semi-Synthetic, derived from thebaine
Relative Strength: 3-7 times STRONGER than morphine
Onset of Action: 5-10 minutes intravenously, 15-30 minutes for suppository formulation
Duration: 3-4 hours for Immediate–Release tablets, up to 12 hours for Extended-Release tablets
History: First synthesized in Germany in 1914, introduced to the United States in 1959
Medical Uses: Oxymorphone is prescribed for moderate-to-severe pain, especially labor pain or dyspnea (shortness of breath) caused by pulmonary edema or left ventricular failure.
Medications that include oxymorphone include:
Unique Side-Effects of Oxymorphone:
Notes about Oxymorphone:
In June 2017, the Food and Drug Administration sought to remove Opana from the market, saying that the potential risks outweighed the benefits. If successful, this would be the second time the drug has been recalled.
“If you're using heroin or opioid drug and you have fentanyl cut into your drug unknowingly, you can be subject to sudden death. These can be kill pills.”
~ Jeff Duchin, Public Health Seattle & King County.
Addiction Risk: Very High
Relative Strength: 50-100 times STRONGER than morphine, while some fentanyl analogues are 10,000 times stronger
Onset of Action: 5 minutes
Duration: 30-60 minutes
History: First synthesized in Belgium in 1959
Medical Uses: Fentanyl is prescribed for severe or chronic pain, especially for postoperative or cancer patients. It is also used as an anesthetic during surgery, and as a sedative during certain medical procedures.
Fentanyl is found in the following medications:
Unique Side-Effects of Fentanyl:
Notes about Fentanyl:
Fentanyl abuse – and overdose deaths – are skyrocketing across the country. For example:
On August 11, 2017, 20 pounds of fentanyl were seized in a raid on an apartment across from Central Park. This was enough to kill “half the population of New York City,” according to Drug Enforcement Agency Special-Agent-in-Charge James Hunt.
The FDA and the CDC now recommend that opioids should only be prescribed as a last resort, when the risks are outweighed by the benefits to “pain and function”. Even then, they should only be prescribed for the shortest duration and smallest dose possible, with frequent reevaluation.
If you are already prescribed an opioid drug your chronic pain, talk with your doctor about any other recommended options that might be right for you.
And, if you or someone you care about is currently struggling with painkiller dependence or addiction, contact a reputable local opioid treatment program to get the help you need to safely recover. In a very real way, your future and your life may depend upon it.