Analgesics by alicejenny

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									Get Up On It

                                Analgesics


        Analgesics (pain medication)
        Analgesics refer to a group of drugs used to temporarily relieve pain. They are sometimes known as painkillers.
        They block pain signals by changing how the brain interprets the signals and slowing down the central nervous
        system. Combining analgesics with alcohol, prescription or illegal drugs can create dangerous and unpredictable
        effects. Even low doses can impair driving ability. There are two main types of analgesics: non-narcotic and
        narcotic.


        Non-narcotic Analgesics
        Non-narcotic analgesics are used to reduce pain from headache, cold, flu, arthritis and many other conditions. They
        normally do not require a prescription and can be purchased over the counter (OTC). There are many OTC pain
        relieving products on the market, which are in tablet or capsule form. Recommended dosage is to repeat every 4
        to 6 hours (if needed) with no more than 6 or 8 capsules or tablets taken within a 24 hour period. The pain relieving
        effects usually last 4 to 6 hours. When taken for no more than 10 days, these drugs can be a safe and effective
        method of reducing pain and fever. There are two major types: acetaminophen (Tylenol®) and non-steroidal anti-
        inflammatory drugs (ASA-Aspirin®, Ibuprofen-Advil® and naproxen sodium-Aleve®).
        Acetaminophen relieves aches, pains and fever, but does not reduce swelling (inflammation). It is easier on the
        stomach than some other pain medications and is safer for children to use. If taken for a long period of time or in
        larger than recommended doses, acetaminophen can lead to liver or kidney damage. This risk is increased with
        regular alcohol use. High doses can lead to liver failure and death.
        Non-Steroidal anti-inflammatory drugs (NSAIDs) are useful for relieving pain, fever and inflammation. ASA has
        a stronger anti-blood clotting effect, making it useful as a blood thinner. One of the major drawbacks of NSAIDs
        is that they can cause stomach irritation and in some cases frequent use causes ulcers or internal bleeding. For
        this reason, pharmacists recommend taking them with meals. For those people, who cannot tolerate NSAIDs, it is
        suggested they take acetaminophen. The use of certain NSAIDs, such as Aspirin®, in children with viral infections,
        is associated with Reye Syndrome. When pain tolerance exceeds the abilities of over the counter medications,
        prescription medications such as narcotic analgesics are considered.


        Narcotic Analgesics
        Narcotic analgesics are also known as opioid analgesics. They are used in medicine as strong analgesics, for relief
        of severe or chronic pain. Other medical uses include control of coughs (codeine, hydrocodone) and treatment of
        addiction to other opioids (methadone). Some opioids, such as morphine and codeine are made from opium, a thick
        white liquid extracted from the unripe seeds of the opium poppy, which grows in southern Asia. Other opioids are
        methadone, meperidine (Demoral®), oxycodone (Percodan®) (Percoset®), hydromorphone (Dilaudid®), fentanyl
        (Duragesic®), pentazocine (Talwin®), propoxyphene (Darvon®), hydrocodone (Vicodin®, Expectorant®) are made
        in pharmaceutical laboratories and are only available by prescription.

        Some pain medications combine ASA and acetaminophen with small amounts of mild opioids such as codeine
        (222s®, Atasol 8® and Tylenol 1®). These medications are available without a prescription, but are kept behind the
        counter and available only through a pharmacist. Some prescription opioids, such as Fiorinal –C®, Vicodin® and
        Peracet® are also combined with ASA and acetaminophen to increase pain relief. Opioid medications can be taken
        orally in tablet or capsule form or injected. They are also available as skin patch, syrup, liquid and suppositories.
        When taken orally, the effects come on gradually and are felt in 10 to 20 minutes. When they are injected, the
        effects are felt almost immediately. Pain relieving effects vary in relation to the type of drug taken. Many opioids last
        up to 4 hours, while other time-release opioids, such as oxycodone last 12 hours. The dosage given for pain relief
        must be gradually increased, so that tolerance to the negative effects can develop. Opioids can provide an euphoric
        (feeling of pleasure) effect, making them susceptible to abuse. Street names include M, morph for morphine, meth
        for methadone, percs or Percodan® or Percocet® and juice for Dilaudid®.


            Effects                                                      Long Term Effects
        •   pain relief                                              •    weight loss, malnutrition
        •   intense sense of well being, pleasure (euphoria)         •    irritability, moodiness
        •   extreme sense of relaxation                              •    blurred vision, reduced night vision
        •   drowsiness, sedation                                     •    chronic constipation
        •   dizziness, light headedness, loss of balance             •    menstrual irregularities
        •   pinpoint pupils, blurred vision                          •    low sex drive, sexual problems
        •   dry mouth                                                •    depression
        •   nausea, vomiting, constipation, loss of appetite         •    poor concentration
        •   headache                                                 •    pain sensitivity, body is unable to make natural
        •   itching                                                       painkillers, small pains seem severe
        •   sweating                                                 •    painful and frequent urination
        •   difficulty with urination                                •    restlessness, sleeping problems
        •   anxiety, depression                                      •    kidney and liver damage
        •   decreased breathing and heart rate                       •    death
        •   labored breathing
        •   hallucinations                                           Whenever injected drugs are used with shared needles,
        •   tremors, seizures                                        there is an increased risk of bacterial and viral infections
        •   loss of consciousness, coma                              such as hepatitis and HIV (the virus that causes AIDS).
Analgesics and Addiction
Non-narcotic analgesics are not addictive. When narcotic analgesics (opioids) are used occasionally under the
guidance of a physician, they can be a safe and effective pain reliever. Regular use of opioids can be psychologically
(the individual feels they need it) addictive and physically addictive (the individual’s body needs it). Tolerance
develops rapidly with regular narcotic analgesic (opiod) use, which means a person requires a greater amount of
the drug to get the same effects or high.


Analgesics and Withdrawal
Non-narcotic analgesics are not physically addictive; therefore withdrawal effects are not experienced. Narcotic
analgesics (opioids) are physically addictive, causing withdrawal symptoms such as craving, hot/cold sweats,
uncontrollable coughing, yawning, sneezing, nasal discharge, muscle pain, insomnia, diarrhea, stomach pain,
nausea, vomiting, sweating, chills, fever, tremors, increased blood pressure and heart rate, anxiety, depression,
restlessness and irritability. The type of opioid used determines when withdrawal symptoms occur and their intensity.
Withdrawal symptoms usually last 7 to 10 days. It is important to see a doctor to discuss a plan for gradually
cutting back. A reduction in dose over time is recommended to lessen the severity of the withdrawal symptoms.
Methadone maintenance treatment is also an option for those addicted to opioids. It may take 6 months or longer
for total withdrawal to occur completely. For more detailed information see Get Up On It Methadone.


Analgesics and Treatment
In Newfoundland and Labrador, drug treatment primarily focuses on supporting an individual to achieve a drug free
lifestyle with improving quality of life as the primary goal. The treatment may focus on abstinence goals or reducing
the harms and risks associated with alcohol, other drug use and gambling. Treatment options include individual
counseling, group therapy, detoxification, inpatient treatment, day treatment, drug therapy and self help groups.
Finding the best option for individuals often requires a combination of approaches.


Analgesics, Pregnancy and Breastfeeding
Non-narcotic analgesics are safe during the first and second trimesters when used occasionally in recommended
doses. The risks increase as more is taken. However, taking non-steroidal anti-inflammatory drugs (NSAIDs) such
as ASA during the last trimester could cause bleeding. The use of narcotic analgesics (opioids) during pregnancy,
may affect the fetus. There is no known safe level of opioid use during pregnancy. It is recommended not to use
opioids during pregnancy. If the mother is being treated for chronic pain, she may wish to explore other, safe options
such as methadone. Narcotic analgesics may increase the risk of complications during delivery, miscarriage,
premature delivery and stillbirth. The infant may have low birth weight, difficulty breathing, be extremely drowsy or
experience withdrawal symptoms. There is little known about the long term effects of opioid use during pregnancy.
Occasional prescribed use of opioids during breastfeeding may be safe, however regular use is not advised. Even
occasional use of opioids may cause drowsiness in the baby. Physician monitored codeine and methadone use
are relatively safe when breastfeeding. Expectant and nursing mothers should consult with their doctor, even if the
drug has been prescribed.


Analgesics and the Law
Non-narcotic analgesics are available without a prescription. It is not illegal to use narcotic analgesics (opioids)
when prescribed by a physician. However, according to the Controlled Drugs and Substances Act, it is illegal
to obtain prescribed opioids without an authorized prescription. It is also illegal to obtain any prescription drug
containing opioids without notifying the physician that you have received a similar prescription within the last 30
days. Possessing and selling narcotic analgesics for the purposing of trafficking is a criminal offense.




Sources
abc’s of Opioid drugs (analgesics), Alberta Alcohol and Drug Abuse Commission, 2007. abc’s of Over-the-Counter Drugs, Alberta Alcohol and Drug Abuse Commission, 2006. Do You
Know…Opioids, Centre for Addiction and Mental Health, 2003. Drugs & Drug Abuse: A Reference Text-3rd Ed, Centre for Addiction and Mental Health, 1998. Effects Series: Opioids,
Alberta Alcohol and Drug Abuse commission, 2007. Facts of Analgesics (Painkillers), The, About.com, Arthritis, 2006. Is it Safe for My Baby, Centre for Addiction and Mental Health,
2003. Opioid Use During Pregnancy, Children’s & Women’s Health Centre of British Columbia, 2003. Over the Counter Drugs: Straight Talk From Your Doctor, British Columbia
Medical Association, 2005. Prescription Pain and Other Medications, NIDA InfoFacts, National Institute of Drug Abuse, U.S. Department of Health and Human Services, 2006. Straight
Facts About Drugs and Drug Abuse, Health Canada, 2000.

Permission is granted to photocopy or cite this publication, provided the source is identified.
For additional information and services contact the Mental Health and Addictions Program with your
local Regional Health Authority or go online at: www.addictionhelpnl.ca or www.getuponit.ca.




                                                                                       2009

								
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