Don't take an opioid painkiller to treat chronic pain until you have tried other, less risky, pain relievers - such as acetaminophen (Tylenol and generic), or a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Advil, Motrin, and generic) or naproxen (Aleve and generic).
Some kinds of chronic or periodic pain in particular - such as nerve pain, migraines, or fibromyalgia - are best treated with other types of drugs, not opioids. Talk with your doctor about nondrug measures, too. Studies show they can ease chronic pain, either alone or in combination with drugs. These include cognitive behavioral therapy, exercise, spinal manipulation, and physical rehab programs.
The weight of medical evidence indicates that while opioids are highly effective - and usually the drugs of choice - in relieving acute severe pain, they are only moderately effective in treating long-term chronic pain, and their effectiveness can diminish over time.
In addition, while the long-term use of opioids has not been well studied, it has been linked to: (1) a decrease in sex hormones leading to both a loss of interest in sex and impaired sexual function; (2) a decline in immune function; and (3) an increase in the body's sensitivity to pain.
Opioids can also be addictive and are prone to abuse and misuse. Even when used to treat pain, they can result in addiction.
If other options fail, your doctor may consider an opioid since controlling pain is always a medical priority. Taking effectiveness, safety and side effects, dosing flexibility and convenience, and cost into account, we have chosen the following opioid as our Best Buy for people with moderate to severe chronic pain when other pain relievers fail to bring adequate relief:
- Generic morphine extended-release
This medicine has a long track record and provides good value. It ranges widely in monthly cost, depending on dosing regimen. But most low-dose regimens will run you $101 or less per month.
High doses of this medicine can be quite expensive. If you need to take a high dose, we advise speaking with your doctor or pharmacist about which opioid has the lowest cost under your insurance plan. If you have to pay out-of-pocket, take care to avoid the high-cost versions of our Best Buy medicine, if possible.
This report was released and last updated in July 2012.
Opioid painkillers such as OxyContin, Vicodin or Percocet work well to alleviate severe short-term pain—due to surgery or an injury, for example—as well as pain associated with terminal or very serious illnesses, such as cancer. Doctors also commonly prescribe opioids to treat longer-term pain such as arthritis, lower-back pain, or nerve pain.
But there's a surprising lack of medical evidence that opioids help much with pain lasting three months or longer and strong evidence that long-term use carries serious risks according to new guidelines from the Centers for Disease Control and Prevention (CDC). For that reason, the CDC as well as other major medical organizations recommend against relying on opioids as the first or only treatment for chronic pain. (Read more about the new CDC advice for treating chronic pain with opioids.)
Besides not working well against chronic pain, opioids commonly cause side effects, including constipation, nausea, and drowsiness or a "fuzzy-headed" feeling. In addition, using the drugs longer term or taking higher doses can also lead to addiction, overdose, and even death. Because of these factors, our Consumer Reports Best Buy Drugs has not chosen any opioid as a “Best Buy.”
Instead of opioid pain drugs, our medical advisers recommend that people first try other treatments for chronic pain. Certain pain such as fibromyalgia, migraines, or nerve pain, other prescription medications may work just as well or better than opioids and are clearly safer. Over-the-counter pain reliever such as acetaminophen(Tylenol and generic), ibuprofen (Advil and generic), or naproxen (Aleve and generic) can provide sufficient relief, especially when combined with nondrug approaches.
Our report, "Pain Relief: What You Need to Know," details a variety of approaches, such as biofeedback, cognitive behavioral therapy, and exercise that, in some cases, can provide just as much or more relief than an opioid, with far less risk.
What Are Opioids?
Some opioids, such as morphine and codeine, are derived from poppy plants. Others are synthetic or partly synthetic, meaning they are chemically manufactured. Some are available in combination with other pain relievers, usually aspirin or acetaminophen. Others are prescribed as single-ingredient products.
Opioid medications work by changing the way pain is experienced and “felt” by blocking pain signals to and in the brain. The drugs affect the body’s central nervous system and cause people to feel sleepy or sedated, and to breathe more slowly. Over time, slowed breathing could damage the heart and lungs because those vital organs don’t get enough oxygen. Opioids can also trigger or worsen sleep apnea, a condition where people stop breathing for short periods during their sleep. Most seriously, opioids can cause breathing to stop completely, leading to death. That risk is greatest when the drugs are taken at high doses or combined with alcohol, sleeping pills, or other medications that make you feel sleepy.
Because opioids can be addictive and carry a potential for abuse, the federal government classifies the drugs as controlled substances. This means that healthcare providers as well as pharmacies and government agencies monitor opioid prescriptions quite closely.
Here’s the list of the most commonly prescribed opioids, in both short- and long-acting forms, and versions available as single ingredient drugs and in combination with acetaminophen:
|Generic Name(s)||Brand Name(s)||Available as a Generic?|
|Buprenorphine||Butrans transdermal film, Buccal film (Belbuca)||No|
|Fentanyl||Actiq, Duragesic (patch), Fentora||Yes|
|Hydrocodone||Lorect*, Lortab*, Norco*, Vicodin*, Zohydro ER||Yes|
|Morphine||Avinza, Kadian, MS Contin CR, OraMorph SR||Yes|
|Morphine plus naltrexone||Embeda||No|
|Oxycodone||OxyContin, Percocet*, Roxicodone, Roxicet*, Endocet*||Yes|
|Tramadol||ConZip, Ultram, Ultracet*||Yes|
CR=controlled release; SR=sustained release; ER=extended release
* These versions contain acetaminophen.
Changes in How Opioids Are Prescribed
Prescribing opioids to treat chronic pain over long periods of time has recently raised serious concern:
- Studies have not proven that opioids work well to alleviate pain, help people move easier, or improve quality of life when used long term.
- Opioids are potentially addictive. You’re at greater risk for addiction if you’ve had anxiety, depression, or other mental health disorders or if you or a close family member has a history of substance abuse.
- Widespread use of opioids by millions of people with chronic pain has contributed to the public health crisis of addiction and overdose deaths. In addition, there is substantial illicit use of opioids.
- Overdoses have quadrupled since 1999 according to the CDC.
- Most people develop a tolerance to opioids, meaning that it takes higher and higher doses over time to get the same effects. And high doses increase the risk of dangerous side effects, including accidental overdose.
- Nearly everyone who takes opioids for longer than a couple of weeks becomes physically dependent on them. That can make it hard to stop taking the drugs without suffering unpleasant withdrawal symptoms, including insomnia, anxiety, and muscle aches.
The increasing awareness that the harms of prescription opioids outweigh any potential benefit for many patients suffering from chronic pain has led to a recent shift in medical practice. Over the last two to three decades, many physician specialty groups and government agencies supported expanded use of opioids to treat long-term pain. But in light of growing evidence of the harms, the CDC and many medical organizations are advising healthcare providers to dial back use of the drugs and to try other safer treatments first.
For example, in September 2014, the American Academy of Neurology (AAN) published a paper recommending against opioids as first-line treatment for headache, fibromyalgia, low-back pain, and other forms of chronic, non-cancer pain. The organization based those recommendations on a lack of evidence that the drugs help people over the long term and concerns about the risk of serious side effects, including addiction, overdose, and death. The AAN also expressed concern that people find it difficult to stop taking the drugs, citing studies showing that half of patients who take opioids for at least three months are still on the drugs five years later.
Nationally, skyrocketing opioid use has led to a public-health crisis:
- Dramatic increases in opioid prescribing and use has been linked to a similar increase in overdoses and deaths over the past decade.
- In 2014, more than 14,000 Americans died of an overdose involving prescription opioids. Many of those deaths occur among people who started taking the drugs for pain according to research by the CDC.
- Nearly 500,000 people are admitted each year to the emergency room because of opioid overdoses or adverse events. And in more than half of those cases people had received a legitimate prescription from their doctor, according to the CDC.
If you are diagnosed with chronic pain, the first decision is whether to take pain medicine at all. Since pain is an entirely subjective experience, only you and your doctor can reach this decision. Pain specialists now emphasize that some people with mild-to-moderate chronic pain can manage well without taking any pain medicines regularly—and may experience improvements in pain and ability to function with nondrug treatments, including exercise, lifestyle adjustments, behavioral therapy, acupuncture, and massage.
If you have bothersome pain despite nondrug measures, you and your doctor may consider treating it with a medication. Talk to your healthcare provider about the risks and benefits of different types of pain drugs in light of your individual symptoms and medical history. Ask how much relief you might expect over the long term, what side effects to be alert for, and what steps to take if the drug doesn’t help.
For many people, an opioid is not the best, first choice for pain relief.
Instead, we recommend trying acetaminophen first. When taken as directed, this pain reliever has a long track record for safety and, even at moderate doses, can be quite effective. In addition, it's available without a prescription and is inexpensive. Use the lowest doses of acetaminophen that provide adequate pain relief—our medical advisers suggest no more than 3,200 mg of the drug in a 24-hour period. If you find that you need to use the FDA's maximum dose (4,000 mg) of acetaminophen or take it every day consult with your doctor about the drug’s link to liver damage and other problems. The risk is greater at higher doses and also in people who drink alcohol heavily, or have existing liver damage or disease.
We also advise keeping track of how much acetaminophen (or any pain reliever) you take. Hundreds of over-the-counter medicines contain acetaminophen, including allergy, cough and cold drugs, fever reducers, and sleep aids. And while the FDA has lowered the maximum per-pill dose of acetaminophen for prescription medicines to 325 mg, unfortunately, it hasn’t taken the same step for the over-the-counter products. Extra-strength Tylenol, for example, contains 500 mg of acetaminophen.
For more details on pain medications as well as nondrug approaches to alleviating pain, see our comprehensive report.
When an NSAID May Be Better
If your pain is not sufficiently controlled by acetaminophen, consider a nonsteroidal, anti-inflammatory drug (NSAID) such as naproxen (Aleve and generic) or ibuprofen (Advil, Motrin, and generic). Our analysis of the evidence shows that all NSAIDs are equally effective, although some people may respond better to one type than another. If one NSAID does not work well for you, try switching to another. If over-the-counter NSAIDs don't work, consider prescription celecoxib (Celebrex and generic) and meloxicam (Mobic and generic).
Aspirin is not a good choice for treating chronic pain because the larger doses typically needed to provide relief, and like other NSAIDs, can cause bleeding in the stomach or intestines, which can be serious. People at high risk of such internal bleeding, and those taking certain other medications, such as blood thinners, should not take any NSAID. If you take NSAIDs frequently and have stomach upset or blood in your stool, see a doctor.
NSAIDs have also been linked to a higher risk of heart disease, heart attack, and stroke, though this risk is very small. Occasional, short-term use of low doses probably does not increase that risk for otherwise healthy people. But for those who already have heart disease or who have high blood pressure, diabetes, or high cholesterol, the risk is greater. Before you start taking an NSAID on a regular basis for chronic pain, and particularly if you take high doses, your doctor should evaluate your risk for heart disease and stroke. This is especially true for people aged 65 and older as the risk for both rises with age.
|Common Types of Pain and Drugs to Treat Them*
This table provides a basic overview of both acute and chronic pain treatment.
|Type of pain||Best initial treatment||If that doesn't work + comments|
|Tensions Headache||Acetaminophen, or an NSAID1 if that does not work||See a doctor if headaches are severe, persistent, or accompanied by fever or vomiting, or you have difficulty with speech or balance. Don’t self-medicate for more than two weeks. Opioids rarely prescribed.|
|Migraines||Acetaminophen, NSAIDs||A triptan or other preventive medication may be needed, especially if migraines are frequent and/or severe. Opioids rarely prescribed.|
|Menstrual cramps||NSAIDs||You don’t necessarily have to use a product marketed specifically for cramps; any OTC NSAID product may be helpful.|
|Pain due to minor trauma (bruises, scrapes, minor sprains)||Acetaminophen, NSAIDs||Opioids are not recommended.|
|Pain due to moderate or severe trauma (wounds, burns, fractures, severe sprains)||Opioids. Other drugs may be prescribed as well||Most people can transition to safer OTC painkillers within three days; few people will need opioids for more than a week.|
|Post-surgical pain — minor||Acetaminophen, NSAIDs||Opioids rarely needed.|
|Post-surgical pain — moderate to severe||Opioids. Other drugs may be prescribed as well||Opioids likely to be prescribed. Most people can transition to OTC painkillers within a week.|
|Muscle aches and strains||Acetaminophen, NSAIDs, muscle relaxants||See a doctor if pain persists.|
|Osteoarthritis||Acetaminophen, oral and topical NSAIDs, topical preparations that provide heating or cooling sensations.||See a doctor if pain persists. Opioids used occasionally for moderate-to-severe pain flare ups, or for chronic pain in appropriately selected patients.|
|Sprains||NSAIDs||Opioids may be needed for severe pain, but patients should transition to safer OTC painkillers as soon as possible, typically within three days.|
|Toothaches and pain following dental procedures||Acetaminophen, NSAIDs||Short-term use of an opioid may be needed if pain is severe.|
|Discomfort and pain due to heartburn or GERD22||Antacids, H2 Blockers (e.g. Tagamet, Zantac), Proton Pump Inhibitors (e.g. Prilosec OTC)||Heartburn that lasts more than a week needs medical attention. Aspirin and NSAIDs should be avoided.|
|Chronic back pain||Acetaminophen, NSAIDs||The antidepressant duloxetine is FDA approved to treat chronic lower back pain. Opioids may be considered if other measures have failed to control persistent, moderate-to-severe pain, but should be part of a comprehensive treatment program that includes nondrug measures such as exercise.|
|Pain from a kidney stone||Acetaminophen, NSAIDs, Opioids||Opioids almost always prescribed if pain is severe.|
|Nerve pain3||Acetaminophen, NSAIDs, Anticonvulsants||Opioids are sometimes used, but only if anticonvulsants or other drugs have been tried and don’t work. Antidepressants, lidocaine patches, and capsaicin cream are other options.|
|Pain due to fibromyalgia4||Antidepressants, Anticonvulsants||Opioids have not proven to be effective in treating fibromyalgia.|
* Important Note: The information in this table is not comprehensive. It is meant as general guidance and reflects typical medical practice. It should not substitute for a doctor's advice. If you have pain that lasts for more than 10 days, see a doctor. The table is based on numerous sources and does not reflect analysis or input from the Drug Effectiveness Review Project. Always follow the labeling or package insert information on nonprescription and prescription drugs you use to treat pain.
- Includes aspirin and aspirin-like drugs such as ibuprofen (Advil, Motrin, and generic) and naproxen (Aleve and generic).
- GERD=Gastroesophageal Reflux Disease, also referred to as stomach acid reflux.
- Associated with diabetic neuropathy, shingles, injury-related nerve damage, compression of nerves in the spine, and nerve damage associated with cancer or HIV infection.
- Fibromyalgia is a condition marked by muscle and joint tenderness and pain. Fatigue can also be present. The cause is unknown. The symptoms it produces and their severity vary widely from person to person.
There is very little research comparing how well different types of opioids work to treat chronic pain. So we do not know if one opioid may be better than another—either overall, or in treating certain types of pain, or treating certain people.
That said, studies do clearly suggest that when a person is given similar doses of any of the opioids, the relief a person experiences from pain is about the same. Opioids also appear to produce similar results when a person’s “quality of life” is measured.
In addition, there are few studies that compare opioids with non-opioid drugs and none that compares the two over a long period of time.
Here are some additional important points about opioid effectiveness, use, and safety from the research literature:
- Most people who take opioids find that the drugs don’t relieve all of their pain. For example, a person who has a pain score of seven on a zero-to-10 scale could have a score of only four or five after taking an opioid.
- Some people may have to take doses so large to get adequate pain relief that risk of side effects outweighs any benefit. Some people are so bothered by the side effects, even at lower doses, that they stop taking the drug. Over time, some people with chronic pain build up a "tolerance" to an opioid. That means they have to take more of it to get the same pain relief. Most doctors are uncomfortable increasing doses past a certain point because the risk of side effects increases with higher doses.
- Most studies evaluating opioids have lasted only three months or less. And there is evidence that they affect the production of certain hormones: testosterone, which can lead to impaired sexual function, and cortisol, which can cause low blood pressure and fatigue. Opioids have also been shown to adversely affect the immune system in people with HIV infection and AIDS.
- Long-term opioid use can actually increase the body’s sensitivity to pain; this is called "opioid-induced hyperalgesia." Although the problem is well-documented, it’s still poorly understood and worries many doctors. The effect could be worse with higher doses—another reason why your doctor may want to limit your opioid dose, even if full pain relief is not achieved.
If tolerance does occur, many doctors believe that switching you to another opioid is an option. There’s little evidence on this, unfortunately, but it can work for some patients.
Also, even when tolerance is not a factor, if you do not respond well to one opioid and increasing the dosage doesn't help, your doctor may choose to try another opioid. Some people simply respond better to one opioid than another, and trial and error is the only way to find that out.
Short Acting Vs. Long-Acting
Long-acting (extended-release) forms of opioid medications stay in the body longer and are available in higher doses than short-acting versions. Many doctors prescribe long-acting opioids for patients with chronic pain because the drugs allow patients to take fewer pills and help prevent breakthrough pain because of a missed dose. But studies suggest that short-acting versions work just as well, even for chronic pain. And, long-acting versions are more likely to cause potentially fatal overdoses in some patients. Because of that risk, the FDA has advised that long-acting drugs be reserved for patients needing strong, round-the-clock help, such as people battling pain from cancer or a terminal illness.
One reason for a cautious approach toward opioids is that they can cause harm. In fact, most people who take an opioid will experience at least one side effect. The most common ones include dry mouth and constipation—which can be severe and require other drugs to relieve—nausea, dizziness, lack of energy, urine retention, slowed breathing, or excessive drowsiness. In studies, about one in five people stopped taking an opioid because of side effects.
Drinking alcohol or taking certain other medications such as tranquilizers, sedatives, and antihistamines worsens some of the side effects of opioids, especially the feelings of being sedated or "fuzzy headed" as well slowing breathing. Many accidental overdoses involve the use of opioids in combination with alcohol or other drugs.
Among the most dangerous types of drugs to combine with an opioid are benzodiazapines, which are used as anticonvulsants, anti-anxiety medications, muscle relaxants, and sedatives—for example, alprazolam (Xanax and generic), clonazepam (Klonopin and generic), diazepam (Valium and generic), and lorazepam (Ativan and generic).
Some side effects, such as nausea, ease over time; constipation can be reduced with laxatives and stool softeners. Others, such as drowsiness and sedation may persist, and can make it difficult to do daily activities like driving or simply concentrating on a task. This can be especially true if you take higher doses.
That’s why many chronic pain patients complain that even if opioids help take the edge off of their pain, the drugs don’t always improve quality of life. Indeed, it’s why opioids can become “part of the problem” for many people with chronic pain, who previously led, or want to lead, active lives.
The box below lists common opioid side effects and adverse events.
|Opioid Side Effects
Some decline over time and/or can be alleviated with other drugs.
Risk of Addiction
One of the most serious concerns about taking opioids is the risk. Opioid addiction has substantially in the last decade as more people take opioids and as recreational use of the drugs has increased.But what’s the risk you’ll get hooked if you start taking an opioid for chronic pain? Can you be said to be “addicted” if you need the drug?
Studies have not precisely defined the risk of addiction when opioids are used intermittently and for short periods to treat flare-ups of pain. But research does indicate that when opioids are used continuously for more than a couple of weeks—even when the drugs are used appropriately to treat severe pain—physical dependence and addiction occur more frequently than previously thought. For example, up to one out of four people treated by a primary care doctor with opioids for long-term pain struggles with addiction according to the CDC.
Experts distinguish between addiction, physical dependence, and tolerance.
- Physical dependence occurs when the body becomes accustomed to a drug. This happens with all opioids and to nearly all people who take them for more than a week or so. It does not mean you are “addicted.” In practical terms, it means when you stop taking the drug, your body will have to adjust. You will likely have some “withdrawal” symptoms, such as sweating, shakiness, irritability, restlessness, jitteriness, insomnia, cold flashes, and involuntary muscle movements. See our medical experts' advice on stopping opioids without suffering withdrawal.
- Tolerance occurs when the effect of the drugs decreases over time. With opioids, this is both good and bad. Good because you may have fewer side effects as your body adjusts to the drug; bad because the amount of pain relief you experience can decrease. To sustain the pain relief, some people need higher doses of the drug. Becoming tolerant to the drug complicates both physical dependence and the risk of addiction. Taking higher doses of an opioid may cause you to become more physically dependent on the drug. That can increase your risk of addiction and make it harder to stop without suffering serious withdrawal symptoms.
- Addiction occurs when you become both physically and psychologically dependent on a drug and it takes control of your life. You may crave opioids between doses, for example, take more than was prescribed, or take them to sleep, relieve anxiety, or achieve a euphoric high rather than treat pain. People who are addicted often continue to seek out the drug regardless of the impact on work or relationships.
Read more about what causes addiction and how to protect yourself.
Who Becomes Addicted?
Experts believe some people are genetically susceptible to becoming addicted to opioids. But there’s no test for that. Having a family history of alcohol and drug abuse is also a risk factor.
All these problems make it essential to take opioids with great care and under the watchful eye of a doctor who knows how to tell when you may be getting addicted. The signs of addiction include:
- Taking higher doses of the drug for a longer time than was originally intended
- Craving opioids—that is, experiencing a strong desire or urge to use them.
- Spending a lot of time focused on obtaining, using, and recovering from the effects of opioids.
- Being unable to cut back or control opioid use even though the drugs are not working well for pain relief and are causing physical or psychological problems.
- Neglecting responsibilities at work, home, or school and missing out on important social and recreational events because of opioid use.
Treatments for opioid addiction exist. We don’t evaluate or compare them here, but they include counseling and support groups as well as medications such as buprenorphine, methadone, and naltrexone that can help reduce cravings.
If You Take an Opioid
If your chronic pain is severe, and not well controlled with other drugs or nondrug treatments, opioids are an option to consider. But before prescribing an opioid drug, your healthcare provider will likely require some information and simple tests.
For example, you may be asked to keep a pain diary for a few weeks, rating how severe your pain is and how often you experience it. Keeping track will give your doctor more detailed information on your pain “patterns.” He or she may also give you one or more tests to clarify how pain is affecting your quality of life. Your doctor is also likely to ask you about past and present drug or alcohol use, whether you have a family history of such problems, whether you are depressed or have anxiety, and screen your urine for opioids or other drugs.
Your doctor is trying to determine whether the benefits of an opioid outweigh the risks. In fact, it’s your doctor’s responsibility to determine if you are at high risk of abusing opioids before prescribing them.
If you wind up taking opioids for long-term pain, the CDC advises starting on the lowest effective dose of a short-acting medication, increasing the dose cautiously, if necessary, and not exceeding a pre-set limit.
Be realistic about your expectations for treatment. In the long run, the drugs will only reduce your pain by about 20 to 30 percent—or they may not help at all. Work with your doctor to set treatment goals and make a plan for what to do if they aren’t met. Your healthcare provider should evaluate your progress using standard assessments of pain and function within one month of when you start taking an opioid, whenever you increase the dose, and at least every three months as long as you take the medication. He or she will also likely test your urine at least once yearly to make sure that you are taking the medication as prescribed.
Your doctor may also ask you to sign an agreement about how your treatment with opioids will be managed. That form will likely spell out how your healthcare provider will prescribe the drugs, how you will be monitored to make sure the drugs are helping and that you are using them safely, and what signs may indicate that you need to stop using opioids or reduce your dose.
Our report summarizes the latest advice on opioid prescribing from the CDC.
Choosing Which One
While we typically designate “Best Buys” for a category of drugs based on effectiveness, safety, and cost, in this case we have not chosen a Best Buy opioid for the treatment of chronic pain. That’s because there’s no good evidence showing that opioids are effective in treating long-term chronic pain, or that any one opioid is any better than another for that purpose. And, the risk of addiction and overdose is too high. Indeed, our medical consultants suggest people should, in consultation with their doctors, try other pain relievers and nondrug treatments first.
That said, if you and your doctor decide you need an opioid to relieve chronic pain or a pain flare-up, we recommend generic versions of hydrocodone/acetaminophen, oxycodone, or tramadol. Our recommendations aren’t based on any evidence that these opioids are better than others. Instead, they are based on cost; these generic versions cost less than $100 a month, on average.
Safe Opioid Use Checklist
✔ Read the label and take the drug exactly as directed. Never take more than advised, don’t take it with alcohol, and don’t combine it with any other drug without your doctor’s OK. Most opioid deaths involve alcohol or sleeping pills.
✔ Get tested for sleep apnea. If you snore loudly, get checked for the condition, because opioids can make it worse or even fatal.
✔ Watch out if you have a respiratory problem. Opioids can interfere with breathing if you have a cold, an asthma flare-up, or bronchitis. So let your doctor know right away, and see whether you need a lower dose until you recover.
✔ Avoid opioids if at all possible if you are pregnant or could become pregnant. The drugs slightly increase the risk of birth defects in a developing fetus as well as the risk that an infant will be born early or underweight. If a woman takes opioids late in pregnancy, her baby could be born addicted to the drugs and suffer withdrawal symptoms in the first days of life. If you are pregnant and need an opioid, talk to your doctor about taking the lowest possible dose for the shortest time.
✔ Don’t drive or do anything that requires you to be fully alert. That’s especially important when you first start taking an opioid or whenever you change the type or dosage.
✔ Put opioids in a locked drawer or cabinet to prevent children from taking them or others from using them for recreational purposes.
✔ Expect regular monitoring. If you are taking opioids, your doctor should assess you at regular visits. If pain and function do not improve at least 30 percent after starting the drugs, then they probably are not working well enough to justify the risks.
✔ Discard unused pills. Take them to your pharmacy or a community drug takeback program. If you can’t, the FDA says, unlike other drugs, opioids are so risky excess pills should be flushed down the toilet.
Our evaluation of opioids in the treatment of chronic pain is based primarily on an analysis from an independent, scientific review of the evidence on the effectiveness, safety, and adverse effects of opioids. The review was conducted by a team of 10 researchers based at the Pacific Northwest Evidence-based Practice Center at the Oregon Health and Science University in Portland and at the University of Washington in Seattle. It was funded by the Agency for Healthcare Research and Quality (AHRQ), published in October 2014 and is available here.
The most recent update of this evaluation reflects CDC guidelines on prescribing opioids for chronic pain, published in March 2016
One of the researchers who co-authored the AHRQ report was a consultant to Best Buy Drugs in updating this report. A physician and specialist in evidence-based research and analysis who is a consultant to Consumer Reports Best Buy Drugs reviewed the AHRQ report and the initial draft of this Best Buy Drugs report and made additional suggestions for revisions. We also contracted with three additional physicians who specialize in pain care to review our report, one of whom served a peer reviewer of the AHRQ report. We thank all these contributors for their valuable assistance and attention to detail.
The AHRQ review probed in detail the findings of 39 studies that evaluated opioids in the treatment of chronic pain. But the review drew on a range of other literature. A list of references appears at the end of the AHRQ paper.