Intravenous (IV) Opioid Use: What You Need to Know

IV opioids aren’t usually the first choice in many situations. But they may be necessary if there are no other options for administering the drug. You might receive opioids by IV in the following situations:

• Sedation: Hospitals may use IV opioids as a component of anesthesia for surgery.
• Post-operation: While in hospital, you may receive opioids by IV to help with pain management.
• Emergencies: If you show up to the emergency department in acute pain, depending on your condition, you may receive IV opioids, like morphine, while waiting. This is especially true for people with cancer.
• Malabsorption: If someone cannot absorb nutrients or medication because of gastrointestinal absorption issues, IV medication, including opioids, is an option.

The Society of Hospital Medicine suggests that healthcare teams only administer opioids by IV in cases where someone can’t take food or medication by mouth or if there’s a need for immediate pain control. Opioids start working about three times as quickly when given by IV compared with orally.

Almost all opioids are available intravenously. A 2018 study found that the four main opioids used in hospitals for the treatment of acute pain in the emergency department were:

• fentanyl (Sublimaze)
• hydromorphone (Dilaudid)
• morphine (Duramorph)
• meperidine (Demerol)

Opioids, whether intravenous or not, carry with them serious risks. Common concerns include:

• tolerance (your body may get used to the dosage and need more to get the same effect)
• physical dependence (symptoms of withdrawal when you stop taking it)
• overdose

Significant side effects can also occur. These include:

• constipation
• nausea, vomiting, dry mouth
• depression
• sleepiness
• lowered testosterone
• delirium
• itching or sweating

In a 2015 study, adverse side effects were more common in people who received opioids by IV compared to other methods.

IV opioids come with some additional risks.

IV opioid use is also more prone to medication error. A 2019 study of a cancer care center in Texas found that more than half of the nurses had administered IV opioids too quickly.

You may have concerns about opioid use disorder (OUD), but this is extremely unlikely from short-term IV opioid use. OUD develops over prolonged opioid use.

Since IV opioids start to work much faster, they have a stronger effect on your brain’s reward system and can increase your risk of OUD. But this is very unlikely in a hospital setting. It’s more likely if you use IV opioids, like heroin, on your own.

It’s important to critically evaluate whether IV opioid use is necessary and whether it’s the best course of action. There may be alternative treatments or ways to minimize the amount of opioids given while still adequately managing pain.

Depending on why you’re getting IV opioids, there may be alternatives your doctor can use.

• Oral: Taking opioids by mouth is the preferred method in most cases. While it has a lower risk of adverse effects, it’s also a slower delivery method than IV. The slower absorption into the bloodstream slightly reduces the “high.”
• Subcutaneous: Opioids can be injected under your skin rather than directly into your veins. Doctors often see this as a middle ground between oral and IV use. A 2018 study recommends subcutaneous use if oral use is not a possibility.
• Transdermal: Some opioids, like fentanyl and buprenorphine, are available as a patch you wear on your skin. A 2017 study concluded that transdermal opioids were safe and effective in managing pain among people with cancer.
• Intranasal: A small 2020 study found that fentanyl taken as a nasal spray may be just as effective in treating pain in cancer patients as IV hydromorphone.

In some cases, your doctor may prefer to use NSAIDs. While they’re less effective initially than opioids, they have an equal effect to opioids within 20 to 30 minutes. But these drugs can affect the GI system and the kidneys, limiting their use.

Depending on the type and severity of your pain, other possible alternatives include:

• ketamine
• nerve blocks
• physical therapy
• acupuncture
• transcutaneous electrical nerve stimulation (TENS)
• spinal cord stimulation (TCS)

Discuss with your healthcare team which options might be best for you.

It’s always a good idea to talk with your doctor, even if it’s just to get clarification or to better understand your treatment or situation. Questions to ask about IV opioids can include:

• Why do I need this drug, and why do I need it intravenously?
• How long will I be on this?
• How can I minimize any risks or side effects?
• What if I have a history of opioid use disorder or substance use disorder?
• Are there any alternative treatments?

If you’re living with or have lived with OUD or substance use disorder, talk with your healthcare team about this to the level of your comfort. Giving as much information as possible is always safest and best, but everyone has different comfort levels with this topic.

Opioids are powerful pain-relieving medications, but they also have the potential for misuse and the development of opioid use disorder. This risk is higher when you receive opioids intravenously.

While IV opioids are not the first-line treatment for many conditions, doctors use them in certain situations, like during or after surgery, or if someone cannot take medication by mouth for any reason.

There’s a very low risk of opioid use disorder after short-term IV use. If this is a concern for you, talk with your healthcare team about your concerns.

Discussing options with your healthcare team can help minimize side effects and the potential for overdose with IV opioids. Feel free to ask questions so you can be well-informed and be involved in making decisions about your treatment.