Opioids • Strong pain relievers

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What are opioids?

Pharmacologists call opioids a group of substances from natural, semi-synthetic and synthetic pharmaceuticals that medical professionals use as strong pain relievers. The best-known opioid is morphine (formerly known as morphine), a natural plant ingredient that is made from the dried milk of the opium poppy. A distinction is made between the different opioids according to their analgesic potency, i.e. according to the strength of their pain-relieving effect.

The strong opioids as well as some combination preparations are subject to the Narcotics Act because of their potential for dependence.

Opioids are used in particular for pain therapy, for acute severe pain or for chronic pain when non-opioid analgesics do not help. Some opioids are used in anesthesia to suppress pain even during anesthesia.

The body's own opioids

There are also opioids made by the body, one of which is endorphin. The brain itself has an endogenous opioid system that can reduce stress, fear and pain and lead to feelings of happiness. In this way we can explain why we feel less pain when we are under stress or fear, for example. However, this body's own system only functions to a certain extent.

What pain relievers contain opioids?

Opioids generally require a prescription (in some cases they are subject to the Narcotics Act) and are not available in pharmacies without a prescription. They can be differentiated in terms of potency. There are numerous opioid pain relievers and combination drugs that contain opioids.

Low-potency opioids (examples):

• codeine
• Dihydrocodeine
• Tramadol
• Tilidine

Strongly effective opioids (examples):

• Morphine
• Buprenorphine
• Oxycodone
• Hydromorphone
• Fentanyl

What is the difference to opiates?

The term opiates stands for active ingredients that are actually obtained from opium poppies or are at least chemically very similar to natural substances. So they contain opium or opium alkaloids. Morphine belongs to this group. Opioids, on the other hand, are also used for synthetic or semi-synthetic substances with a morphine-like effect.

How do opioids work in the body?

Opioid analgesics are also referred to as opioid analgesics. This includes any pain reliever that works on opioid receptors by reducing pain. Opioid receptors are the body's own cellular binding sites, which are mainly located in the central nervous system, i.e. in the brain and spinal cord, but also in many peripheral organs such as the gastrointestinal tract. Opioid analgesics attach to these receptors and activate them. As a result, the neurons are less excitable, so the nerves transmit the stimulus – in this case pain – only in a weakened manner. Accordingly, opioids primarily act on the central nervous system by inhibiting or suppressing the transmission and processing of pain stimuli.

Areas of application: when and how do you use opioids?

Pain therapy with opioid analgesics is often used for tumor pain, after major injuries and during operations, but generally only when non-opioid painkillers do not work or are insufficient. Patients receive the respective opioids either as an injection or take them, for example, as a tablet, capsule or drops. Some of the pain relievers are also available in the form of nasal sprays or patches.

In principle, doctors should choose opioids with the lowest possible potency and the lowest sensible dose. It is also important to closely monitor the level of active ingredients in the blood of those affected, as well as any side effects or changes.

Blood concentration important

The concentration of the pain reliever in the blood should fluctuate as little as possible in order to achieve the analgesic effect. In order to ensure a consistently high level, those affected take the medication regularly and according to a fixed schedule, or the attending physician administers them at fixed times. It can also be used with patches that release their active ingredient continuously and in the appropriate amount through the skin. This can be useful for people who are particularly stable or under control, have difficulty swallowing or are very forgetful.

Pain: Acute or Chronic

Accidents or major operations can lead to acute severe to very severe pain. If non-opioid pain relievers do not work here or do not work sufficiently, opioids can be the right variant for pain therapy.

For chronic, non-tumor-related pain, opioids have only limited effectiveness. According to studies, they can help with chronic diseases such as nerve pain in diabetes, painful joint wear, chronic back pain or after shingles for up to three months. Since opioid analgesics have side effects and can make you apathetic and even addictive in the long term, they should not be used for long-term medication.

In the case of long-lasting pain, opioids are not generally more effective than other painkillers. In some cases it can be useful to combine different pain relievers. In the case of long-term pain, doctors usually rely on a combination of medicinal, physiotherapeutic and psychological measures.

Opioids in cancer

Opioid analgesics are often an important part of pain management for people with certain types of cancer. As a rule, doctors carry out pain therapy for cancer according to the WHO level scheme.

The German Cancer Research Center warns against waiting for cancer patients to take opioid painkillers until they can no longer bear it. The effectiveness is better if you start the therapy in time. Depending on the medical history and findings, doctors may prescribe medication in which the active ingredient is only released gradually and very evenly, such as so-called sustained-release capsules or plasters.

What are opioids not used for?

According to the German Medical Association, opioids should not be used for the following diseases, as they have little or no effect or the expected side effects predominate:

Contraindications: contraindications

Certain diseases can also be so-called contraindications. This means that if they are present, those affected are not allowed to take certain opioids. This can be, for example, lung or liver disorders, a traumatic brain injury as well as alcohol or sleeping pill poisoning. There are also important restrictions to be observed during pregnancy and breastfeeding. Opioids also have an immunosuppressive effect. This means that they suppress the immune system and can therefore increase the risk of infection and are therefore unsuitable for certain patients.

Side effects of opioids

Quite common side effects when taking opioids are sluggishness and constipation, which usually do not go away even after a period of habituation. Doctors therefore often recommend preventive home remedies such as prunes or flaxseed, or they prescribe a laxative. During the first few weeks of therapy, you may also feel nausea, tired, or weak. Itching or cardiovascular complaints such as dizziness are less common.

Possible side effects:

• nausea
• dizziness
• constipation
• dry mouth
• Tiredness, feeling weak
• itching
• Drop in heart rate and blood pressure
• increased sweating
• low level of sexual pleasure
• Menstrual irregularities

Can you drive a car while taking opioids?

Whether you can drive a car during treatment with opioid analgesics should always be discussed with the treating doctor on a case-by-case basis. What is certain is that these painkillers can impair the complex sensory-motor performance of those affected. This means that controlling machines and driving vehicles may no longer be as guaranteed as without medication.

Addiction: Are Opioids Addicting?

Treatment with opioids for more than four weeks can lead to physical dependency (habituation). However, that doesn't mean you are addicted yet. In addition to reducing pain, opioids also have an anxiolytic and mood-enhancing effect. However, it decreases with long-term use. This can lead to a development of tolerance. When the affected person finally stops taking the drug, the body lacks external support for its psyche and psychological withdrawal symptoms can occur.

Here it is important that the intake, dosage and discontinuation of opioids take place under constant medical supervision in order to prevent independent re-dosing and thus addiction. Because of the side effects and the possibility of developing an addiction, opioids are not suitable for long-term medication, except for cancer therapy.

Opioids: Are There Withdrawal Symptoms?

When pain therapists stop using opioids, they do so gradually to reduce possible withdrawal symptoms. And yet physical reactions such as sweating or freezing, and more rarely diarrhea or vomiting can occur. However, psychological withdrawal is usually more difficult than physical withdrawal. Opioids can help you sleep better, brighten your mood, and relax. If the person concerned lacks the active ingredients, it can lead to sleep difficulties or even depressive moods.

Overdose: stop breathing due to opioids?

Severe overdosing or abuse of opioids can lead to the dreaded opioid poisoning (opioid intoxication). It leads to a drop in blood pressure and pulse, possibly to respiratory depression, which can lead to life-threatening respiratory failure. Disturbances in consciousness and a conspicuous constriction of the pupils are also characteristics of a severe overdose. Such overdoses are known, for example, from addiction patients who consume heroin and opium in an uncontrolled manner. These are well-known intoxicants that also belong to the group of opioids.