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These Pain Killers "Have Risks," Physician Warns

Know the risk before you will take them.
FACT CHECKED BY Emilia Paluszek

The current opioid crisis is now largely attributed to widespread increases in the prescribing of opioid painkillers starting in the late 1990s. Over the past two decades, I've treated patients in my clinical practice who have become addicted to opioids (including heroin and fentanyl), but often these patients got opioids from friends or dealers. Not prescribers. It is now outdated to assume that someone with opioid addiction began with prescribed opioids. This has made it really hard for pain patients with legitimate pain syndromes who struggle to access treatment, especially with controlled substances that have been vilified in some circles. And yet painkillers (a loose term for prescription opioids) do have risks and should be used as prescribed, under ongoing medical supervision, and with caution. Read on to find out more—and to ensure your health and the health of others, don't miss these Sure Signs You've Already Had COVID.


The One You Mix With Alcohol or Other Sedatives

wine and medication

Every class of medication has its own characteristics and metabolic profile. However drug-drug interactions can often overwhelm organ systems much more dramatically than a single medication used in isolation. For instance, combining opioids with benzodiazepines (Xanax, Klonopin, or a close cousin like Ambien) can greatly increase risk of overdose. Combining with alcohol, even just one or two drinks, can similarly increase risk.


Long-Acting Medications

Woman Reading Pill Bottle Label

Methadone is a good example. Someone's blood levels continue to rise for 24-36 hours after taking a methadone dose. Which means if someone takes two doses a day, whether prescribed or by accident, their blood levels could climb higher than someone who just takes the same dose once a day. This can lead to fatal overdoses while people or sleeping, or even the day after someone takes their final dose because the medication is so long acting. As a result, methadone programs for the treatment of addiction are highly regulated so that people do not have unfettered access to medication and accidentally take a fatal dose.

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Mislabeled Prescriptions

man with prescription medications

Part of why Oxycontin led to so much addiction is because it was advertised as a 12-hour long analgesic. However, the analgesia (or pain relief) only lasted 6-8 hours. As a result, patients took Oxycontin three times a day instead of two times a day. It is pretty obvious in retrospect but at the time it looked like patients were overtaking their medication and possibly had an addiction. A term was even used, "pseudo addiction" when these behaviors became more recognized. What is now known is that the Purdue pharma company was aware that the pain relief only lasted 6-8 hours and yet they intentionally kept advertising it to doctors and patients as lasting 12 hours. Of course now they are bankrupt and widely seen as criminals.

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Anything From the Street

man holding a glass of alcohol and a handful of pills

Unless you have picked up the prescription from the pharmacy (or a trusted family member/spouse/parent) did, you should now assume it is a fake. Any powder or pill from the black market is likely to be laced with many, possibly dozens, of adulterants. This is now such a big problem that the DEA created an awareness campaign entitled, "One Pill Can Kill." And this time, it isn't an exaggeration. Anything pill from the black market should be considered toxic and destroyed or discarded immediately. A lot of desperate patients with poorly treated pain also turn to the internet, just like curious youth or recreational drug users. But unless the prescriptions are coming from a verified pharmacy regulated by the FDA and DEA, online sales should be considered black market sales. It is incredibly dangerous.

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Quick Acting Medications


While quick-acting medications can be desirable for injuries (think about IV morphine on the battlefield or after a car crash in the Emergency Room), ongoing use of medications that bring fast relief can increase the abuse liability and addictive potential. Onset of action is easier to think about, but steep offset of action can also reinforce addictive potential leading to people taking more and more of a given painkiller. Over time tolerance builds and yet people remain uncomfortable as they are often cycling rapidly through withdrawal cycles and rebound symptoms. And to protect your life and the lives of others, don't visit any of these 35 Places You're Most Likely to Catch COVID.

Arthur Robin Williams, MD, MBE
Arthur Robin Williams MD MBE, Medical Director, Ophelia Health Read more about Arthur Robin
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