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 slowing down the
central nervous system and changing how the brain interprets these signals.
Combining analgesics with Alcohol, prescription or illegal drugs can create
dangerous and unpredictable effects. Even low doses of analgesics 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 headaches, colds, flu, arthritis
and 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 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 they
are taken for no more than 10 days, they 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, and the
risk increases with regular Alcohol use. High doses can even 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 and is
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 can cause 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 opioids 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 unripe seeds of the opium
poppy from 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. These
medications are available only by prescription.

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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 a 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 a euphoric
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 (of Narcotic Analgesics/Opioids)

• pain relief
• intense sense of well-being, pleasure, euphoria
• extreme sense of relaxation
• drowsiness, sedation
• dizziness, light headedness, loss of balance
• pinpoint pupils, blurred vision
• dry mouth
• nausea, vomiting, constipation, loss of appetite
• headache
• itching
• sweating
• difficult urination
• anxiety, depression
• decreased breathing and heart rate
• labored breathing
• hallucinations
• kidney and liver damage
• tremors, seizures
• loss of consciousness, coma, death

Whenever injected drugs are used with shared needles, there is an increased risk of serious
bacterial and viral infections such as hepatitis and HIV (the virus that causes AIDS).

Long-Term Effects (Narcotic Analgesics/Opioids)

• weight loss, malnutrition
• irritability, moodiness
• blurred vision, reduced night vision
• chronic constipation
• menstrual irregularities
• low sex drive, sexual problems
• depression
• poor concentration
• pain sensitivity, body is unable to make natural painkillers, minor pain seems severe
• painful and frequent urination
• restlessness, sleeping problems

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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 addictive and physically
addictive. Users develop a tolerance quickly, needing a greater amount 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 and nasal discharge, muscle pain and spasms, 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 will occur and their intensity.
Withdrawal symptoms usually last 7 to 10 days. It is important to see your doctor
to discuss a plan for gradually cutting back. A slow 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.

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, and it is recommended not to use opioids during pregnancy. If the mother
is being treated for chronic pain, it is advised to find other options like 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 used 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/or selling narcotic analgesics for the purposing
of trafficking is a criminal offense.

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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

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