Patients' Frequently Asked Questions About Prescription Opioids

Using prescription opioids

Prescription opioids are sometimes used to treat moderate-to-severe pain. Because prescription opioids have a number of serious side effects and potential risks, you can ask questions, learn more about opioids, and understand their risks before taking them. Talking openly with your doctor can help make sure you're getting care that is safe, effective, and right for you.

Your clinician should ensure equitable access to effective, informed, individualized, and safer pain management that improves your function and quality of life, while working with you to reduce the risks associated with opioid use.

About opioids

What is the difference between acute, subacute, and chronic pain?

• Acute pain is pain that usually lasts less than 1 month and has a known cause, like an injury or surgery. It normally gets better as your body heals.
• Subacute pain is pain that lasts longer than 1 month but not more than 3 months.
• Chronic pain is pain that lasts 3 months or more and can be caused by a disease or condition, injury, medical treatment, inflammation, or even an unknown reason.

What are prescription opioids?

Opioids are natural or synthetic chemicals that reduce feelings of pain. Prescription opioids include:

• Hydrocodone (such as Vicodin®, Norco®)
• Oxycodone (such as OxyContin®, Percocet®)
• Morphine (such as MS Contin®, Kadian®)

What should I consider before taking opioids?

Prescription opioids (opioid therapy) can be used to treat pain. There is very limited evidence that they are effective for long-term use. If you're prescribed an opioid, the best approach is to use it only when pain is severe, and to stop using it as soon as possible.

Before taking opioid medication for pain:

• Set treatment goals with your clinician for pain and function in your daily life.
• Talk to your doctor about pain treatment options, including ones that do not involve prescription opioids.
• Discuss the risks and benefits of opioid therapy.
• Talk openly with your doctor to make sure you're getting care that is safer, more effective, and right for you.
• Tell your doctor about your medical history and if you or anyone in your family has a history of substance use disorders (SUDs).

Risks of using opioids

Will I develop an opioid use disorder?

Anyone who takes prescription opioids can become addicted to them. You may also develop tolerance—meaning that over time you might need higher doses to relieve your pain, putting you at higher risk for a potentially fatal overdose. You can also develop physical dependence—meaning you have withdrawal symptoms when the medication is stopped.

How do I take and store opioids properly?

• Never take prescription opioids in greater amounts or more often than prescribed.
• Avoid taking opioids with alcohol and other substances or medications. It is very dangerous to combine opioids with other drugs, especially those that cause drowsiness, such as:
  • Benzodiazepines (such as Xanax® and Valium®)
  • Muscle relaxants (such as Soma® or Flexeril®)
  • Sleep aids (such as Ambien® or Lunesta®)
  • Other prescription opioids
• Do not share or sell your prescription opioids.
• Store prescription opioids in a secure place, out of reach of others (including children, family, friends, and visitors).
• Dispose of unused prescription opioids at the end of your treatment. Find your community drug take-back program or your pharmacy mail-back program, or flush them down the toilet following guidance from the Drug Disposal: FDA's Flush List for Certain Medicines | FDA.

Can I avoid side effects and risks of opioids?

No. Opioids carry considerable potential risk to patients. Anyone taking prescription opioids is at risk for unintentional overdose or death and can become addicted. Since 1999, approximately 294,000 people have died from a prescription opioid overdose.1

In addition to the serious risks of opioid use disorder and overdose, the use of prescription opioids can have several side effects, even when taken as directed.2 Review these with your doctor so you know what you may expect:

• Tolerance - meaning you might need to take more of the medication for the same pain relief
  
• Physical dependence - meaning you have symptoms of withdrawal when the medication is stopped
• Increased sensitivity to pain
• Constipation
• Nausea, vomiting, and dry mouth
• Sedation and dizziness
• Confusion
• Depression
• Low levels of testosterone that can result in lower sex drive, energy, and strength
  

Remember, your doctor is a partner in your pain treatment plan. It's important to always let your doctor know about any side effects that you experience or concerns you have about using opioids.

What increases my risk of overdose from opioids and other drugs?

Risk of opioid overdose and death increases at higher dosages and when taken for longer periods of time or more often than prescribed. It is also very dangerous to combine opioids with other drugs, especially those that cause drowsiness. Overdose risk increases when using counterfeit pills (pills obtained illegally or without a prescription), or when your opioid medication is combined with:

• Alcohol
• Benzodiazepines (also known as "benzos," including diazepam [Valium®] and alprazolam [Xanax®])
• Other sedatives like certain sleep medicines and muscle relaxants
• Other opioids (prescription or illegal, including illegally-made fentanyl and heroin)
  

You can talk to your doctor about any other medications you are using.

Work out a plan to call your doctor if you continue to experience pain. Also ask about the serious side effects of opioids (like sedation) so you and your family know when to call a doctor or call 911.

Anyone who uses opioids can experience an overdose, but certain factors may increase risk that your clinician can consider when prescribing opioids:

• Having a history of overdose or a substance use disorder
• Having sleep apnea or other sleep-disordered breathing
• Taking higher dosages of opioids (e.g., ≥50 morphine milligram equivalent [MME]/day)
• Returning to a high dose after losing tolerance (e.g., patients undergoing tapering or recently released from prison)
• Taking benzodiazepines with opioids
• Having kidney or liver disease
• Being 65 years and older

Are there resources to help me learn more about the risks and benefits of opioids?

These web pages will help you learn more about prescription opioids:

2022 Clinical Practice Guideline

What is the 2022 Clinical Practice Guideline and how does it affect me?

The CDC Clinical Practice Guideline for Prescribing Opioids for Pain (2022 Clinical Practice Guideline) is voluntary guidance for clinicians that was created to help inform decision making. The recommendations were developed for clinicians who provide pain care — including those prescribing opioids — for adults with short- and long-term pain. The 2022 Clinical Practice Guideline aims to help clinicians and patients work together to ensure the safest and most effective pain care can be provided.3

This publication updates and replaces the CDC Guideline for Prescribing Opioids for Chronic Pain released in 2016.

What does the 2022 Clinical Practice Guideline mean for me and my long-term opioid therapy?

The CDC Clinical Practice Guideline for Prescribing Opioids for Pain–United States, 2022 updates and replaces the CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. The new guideline includes recommendations on determining whether or not to initiate opioids for pain, selecting opioids and determining opioid dosages, deciding duration of initial opioid prescription and conducting follow-up, and assessing risk and addressing potential harms of opioid use.

The 2022 Clinical Practice Guideline does not support rapid tapering, patient abandonment, or abrupt discontinuation of opioids. A critical piece of the 2022 Clinical Practice Guideline is the incorporation of new guidance to help clinicians and patients carefully weigh the benefits and risks of tapering opioids or continuing opioids. Specifically, it advises against abrupt discontinuation as well as rapid dosage reductions of opioids. It also recommends that tapers be used when treatment is discontinued after opioids have been used continuously for more than a few days, to prevent withdrawal symptoms. Expanded practical tips on tapers are outlined to help clinicians work with patients already receiving opioids in determining whether to taper medications and how to taper them if the decision is made to do so.

The 2022 Clinical Practice Guideline is flexible and encourages individualized care. It encourages clinicians to create or update a pain treatment plan with their patients, based on the patient's individual needs and circumstances. You and your doctor can work together to determine your treatment goals and path forward.

Does CDC require my doctor to follow the 2022 Clinical Practice Guideline?

No. This voluntary guideline provides recommendations only and is meant to support patients and clinicians in making decisions about pain treatment that are safe, effective, and right for the patient. These recommendations are for patients 18 and older in outpatient settings with acute pain, subacute pain, or chronic pain.

Note: The voluntary guideline does not apply to patients experiencing pain with the following conditions or settings:

• Pain management related to sickle cell disease
• Cancer-related pain treatment
• Palliative care
• End-of-life care