When opioids are taken as prescribed by a medical professional for a short time, they can be relatively safe and can reduce pain effectively. However, taking prescription opioids, puts you at risk for dependence and addiction. Dependence means you feel withdrawal symptoms when you stop taking the drug. Continued use can lead to addiction, where you continue to seek out the drug and use it despite negative consequences. These risks increase when the medications are misused. Prescription medications are some of the most commonly misused drugs by teens, after tobacco, alcohol, and marijuana.

Opioid medications can be natural, created in labs from natural opioids, or synthetic (human-made). Common opioids and their medical uses are listed below.

Fentanyl is a powerful synthetic (human-made) opioid that is 50 to 100 times stronger than morphine, and is prescribed for extreme pain. It is extremely dangerous if misused, and is sometimes added to illicit drugs sold by drug dealers. Find out more about Fentanyl.

How Prescription Opioids Are Misused

People misuse prescription opioid medications by taking them in a way that is not intended, such as:

• Taking someone else’s prescription, even if it is for a medical reason like relieving pain.
• Taking an opioid medication in a way other than prescribed—for instance, taking more than the prescribed dose or taking it more often, or crushing pills into powder to snort or inject the drug.
• Taking the opioid prescription to get “high.”
• Mixing it with alcohol or certain other drugs. Your pharmacist can tell you what other drugs are safe to use with prescription pain relievers.

There are multiple medications that can help relieve low back pain associated with degenerative disc disease. Any medication, including many non-prescription (over-the-counter) drugs, should be taken under a physician’s care, direction, and supervision. Many of the pain medications below should not be taken by people with certain health conditions (e.g., diabetics should not use oral steroids since the medication increases blood sugar levels). Patients should ask their physicians and pharmacists about potential side effects of any medication.

• Acetaminophen (such as Tylenol) is a pain medication that works by dampening the brain’s perception of pain. Unlike non-steroidal anti-inflammatory drugs, acetaminophen does not treat the inflammation that usually accompanies pain from a degenerated disc. In addition to its efficacy for addressing low back pain, acetaminophen is frequently recommended because it has relatively few side effects. Acetaminophen is available without a prescription and is generally considered to be one of the more effective pain relievers for treating painful flare-ups caused by degenerative disc disease.
• NSAIDs, or non-steroidal anti-inflammatory drugs, are a class of pain medications that help reduce the inflammation in the low back that is associated with lumbar degenerative disc disease. NSAIDs comprise a large class of pain medications with many different options. In addition to aspirin, there are currently several types of both non-prescription (over-the-counter) NSAIDs and prescription brands of NSAIDs. The three types of NSAIDs most commonly used to treat low back pain from degenerative disc disease include:
  • • Ibuprofen (e.g. brand names such as Advil, Motrin)
    • Naproxen (e.g. brand names such as Aleve, Naprosyn)

  inflammation.

Taking NSAIDs regularly in the appropriate dose lets the drug build up in the system in order to have an anti-inflammatory effect and provide a better healing environment for the low back. For recurrent episodes of low back pain and/or chronic pain, it is usually less effective to take NSAIDs only at the onset of pain. Sometimes doctors will recommend taking both NSAIDs and acetaminophen to address both the pain and underlying inflammation.

• Oral steroids, a non-narcotic type of prescription medication, are very powerful anti-inflammatory medications that are sometimes an effective treatment for low back pain from degenerative disc disease. Typically, oral steroids for low back pain from degenerative disc disease are prescribed in a Medrol Dose Pack, starting with a high dose to kick-start the impact of the medication and provide initial low back pain relief, then tapering down to a lower dose over five or six days. Because chronic steroid use leads to many possible complications, their use is limited to short period of time (one to two weeks) and is generally used only for flairs of severe pain.
• Muscle relaxants (such as Soma, Flexeril, and Valium) work by having an overall sedative effect on the body. Typically, muscle relaxants are prescribed early in a course of low back pain to alleviate pain caused by

Opioid medications are strong pain relievers widely used to treat back pain. These medications change the perception of pain by weakening pain signals to the brain. Emotions are also affected, leading to a feeling of enhanced well-being and sleepiness in many people.

Opioids are derived from the opium poppy plant or made synthetically. Some opioids contain both opium-derived and synthetic material.

Because of the potential side effects, risks, and complications of opioids, and the body’s increasing tolerance to opioids over time, these medications are most clearly indicated for treatment of short-term intense pain, such as acute postoperative pain. If used to treat pain for longer periods, close monitoring is essential.

Common Types of Opioids

Opioids vary in strength and have different uses. They are available in immediate and extended-release forms.

Opioids are classified by the U.S. Drug Enforcement Agency based on their medical benefits and potential for abuse or dependence. The classification goes from Schedule I to Schedule V, with the drugs considered most dangerous having the lowest numbers.

Common opioids include:

• Fentanyl (brand names Actiq, Abstral, Duragesic, Fentora, Lazanda, Subsys) is designed for cancer patients who have flares of pain (sometimes called breakthrough pain) that are not controlled by other medications. It is available as a nasal spray, tablets, lozenges, and as a patch. Fentanyl is an extremely strong pain medication and distribution of some forms is restricted.
• Hydrocodone (brand names Hysingla ER, Lortab, Norco, Vicodin, Zohydro ER, and others) is often combined with acetaminophen (Vicodin) or other non-opioid medication and is designed for pain that is moderate to moderately severe.
• Hydromorphone (brand names Dilaudid, Exalgo) is intended for moderate to severe pain. It is available in multiple forms, including liquid and tablets. Extended-release forms are also offered.
• Meperidine (brand names Demerol, Meperitab) is advised for moderate to severe pain, and is available as a syrup, injectable solution, or tablet.
• Methadone is used to treat pain as well as for detoxification from illicit opioids, such as heroin. It is available as a tablet, liquid, or a small disc that can be added to water or certain other liquids.
• Morphine (brand names Kadian, MS Contin, Embeda, MorphaBond, Roxanol, and others) is commonly used to treat intense pain related to surgery. Patients may be given this medication for a short time intravenously in the hospital. It is also available as a tablet, oral solution, and in other forms. Extended release formulations are other options.
  • Oxycodone (brand names OxyContin, Xtampza ER, Roxicodone, Percocet, Percodan, and others) is often combined with a non-opioid pain reliever, such as acetaminophen or aspirin. It is available in different forms, including as an oral solution and tablets. Extended-release tablets are also available. Oxycodone is an option for moderate to severe pain.
  • Tapentadol (brand name Nucynta) is intended for moderate to severe pain. Extended-release tablets are available.
• • Codeine is often combined with non-opioid pain medications, such as acetaminophen. It is typically used for less serious pain. Codeine is sold in multiple forms, including as a tablet, suspension, and liquid. Codeine may be best known for its use as a cough syrup. Codeine tablets are classified as Schedule III and codeine liquid is Schedule V.
    

    Schedule III

    • Buprenorphine ((BuTrans/Belbuca, Suboxone) relieves moderate to severe pain and is also used to treat opioid addiction. It is available as a tablet and as various films that dissolve in the mouth.

    Schedule III and Schedule V

  • Tramadol (brand names ConZip, Synapryn, Rybix ODT, Ryzolt, Ultram, Ultram ER) is generally recommended for patients with moderate to moderately severe pain. It is available as a tablet, capsule, and orally disintegrating tablet, and for extended release (ER). Tramadol may also be combined with acetaminophen (e.g. Ultracet).

Benzodiazepines like Xanax work by attaching to a receptor in your brain called the GABA-A (gamma-aminobutyric acid-A) receptor. When Xanax binds to this receptor, it has a calming effect in the brain.

For anxiety disorders, Xanax is often prescribed because it can help relieve anxiety symptoms quickly. However, other anxiety medications and talk therapy are better long-term choices for treating anxiety because Xanax has side effects, a risk of overdose, and the potential for dependence.

These other treatments may take a few weeks to take effect, though. So Xanax and other benzodiazepines are sometimes used as a “bridge” until other treatments can have a chance to work.

For treating insomnia, behavioral therapy and other medications are also generally preferred over Xanax.

How long does Xanax last?

Most people notice that Xanax will start to work within 1 to 2 hours. For healthy younger adults, half the dose of Xanax has left the body somewhere between 6.3 to 26.9 hours. The average is around 11 hours.

It takes a little longer for Xanax to leave the body of healthy elderly people. Half the dose of Xanax has left the body in elderly people somewhere between 9 to 26.9 hours. The average is around 16 hours for this group.

However, people stop feeling the effects of Xanax long before it leaves the body, which is why it is often taken more than once a day. It’s important to take it as prescribed. Taking too many doses can lead to dependence and accidental overdose.

What are some of the concerns of taking Xanax?

If you are taking Xanax, you should be aware of its side effects. Possible side effects include:

• Sleepiness
• Dizziness
• Headache
• Confusion
• Muscle cramps
• Decreased appetite
• Weight loss or weight gain
• Diarrhea
• Nausea or vomiting
• Manic symptoms
• Difficulty walking
• Dry mouth
• Irregular heartbeats
• Low blood pressure
• Blurry vision

Some people should avoid Xanax because they may be more sensitive to its side effects or it might harm them. These groups include:

• Pregnant women
• Older patients
• Children and teens
• People who have misused alcohol or drugs
• People with certain medical conditions such as respiratory illnesses

People who take Xanax should also be aware of the possibility of misusing or becoming dependent on it. Some people misuse Xanax because they like the way it makes them feel, which can lead to inappropriate use or overuse. When someone needs higher or more frequent doses of the medication to achieve the same effect, this is known as tolerance.

Building a tolerance to Xanax or other benzodiazepines can lead to dependence. A dependence means your body begins to rely on Xanax to function normally, and you can experience serious withdrawal symptoms if you stop taking it suddenly.

Certain people are at greater risk for misusing Xanax, including:

• Non-Hispanic whites
• Young adults 18 to 35 years old
• Someone who has a current psychiatric disorder
• Someone with a personal or family history of substance abuse

With 80% of the Medicare Part D beneficiaries who are at-risk of misusing or overdosing on opioids receiving extreme amounts of the type of drug, HHS’ Office of the Inspector General recommends that CMS do more.

A new federal report recommends CMS take a more active role in ensuring Medicare beneficiaries get access to treatment for opioid use disorder after finding less than a tenth of at-risk patients received medication-assisted treatment in 2017.

The analysis, released Thursday by the HHS Office of the Inspector General, identified more than 71,000 Medicare Part D beneficiaries of being at serious risk for misusing or overdosing from opioids in 2017.
Approximately 80% of those beneficiaries received “extreme amounts” of opioids that year, defined as taking an average daily morphine equivalent dose of 240 mg for 12 months. The report found more than 14,000 in 2017 showed signs of engaging in ‘doctor shopping’, which was defined as taking an average daily morphine equivalent dose of more than 120 mg for at least three months during the year plus getting medications from four or more opioid prescribers and four or more pharmacies.

The report did show progress had been made in decreasing opioid use among at-risk beneficiaries. The number of those who received extreme amounts of opioids fell from 57,611 in 2017 to 27,137 in 2018. The biggest decline was among those who engaged in doctor shopping, the number of which decreased from 14,814 beneficiaries in 2017 to 2,452 in 2018.

But four out of five beneficiaries at serious risk of opioid misuse or overdose in 2017 still received high amounts of opioids in 2018.

Study co-author Miriam Anderson, a team leader in HHS OIG’s Office of Evaluation and Inspections, said the findings indicate efforts to reduce or stop the use of opioids among high-risk beneficiaries need to be improved.

“We were particularly concerned about this group because receiving these extremely high amounts or having behaviors that appear to be doctor shopping can signal that their care is not being monitored or coordinated properly, or that the beneficiary’s care needs to be reassessed,” Anderson said.

The need to monitor and track opioid use among at-risk beneficiaries is especially important now when many addiction treatment centers have been forced to scale down their services due to shelter in place orders as a result of the COVID-19 pandemic. Experts have said the temporary loss of in-person counseling services has increased anxieties among those with substance use disorder, which raises the risk of them relapsing.

HHS OIG on Thursday also released a toolkit to instruct stakeholders how to use prescription drug claims data to analyze patients’ opioid levels and identify certain patients who are at risk of opioid misuse or overdose.

Despite the progress in monitoring, the report found more needed to be done to expand treatment. Roughly half of the at-risk beneficiaries were diagnosed with opioid use disorder in 2017 or 2018, with just 7% receiving medication-assisted treatment through Part D.

Anderson said the fact that only a small share of beneficiaries received MAT highlights the challenges they face in accessing treatments from prescribers.

Medication-assisted therapies like buprenorphine and methadone are considered part of the gold standard for treating opioid use disorder. A study published in JAMA Network Open in February found buprenorphine and methadone was associated with a 58% decrease in drug overdoses over a 12-month span.
The report recommended CMS develop strategies to raise awareness among providers and Part D beneficiaries about how to get access to MAT drugs.

But tight regulations around prescribing both medications have limited their access. Methadone can only be dispensed at one of nearly 1,500 federally approved opioid treatment programs, while healthcare providers must complete eight hours of training to get a waiver to be allowed to prescribe buprenorphine.

“There’s concern that they may have not had access to, or known how to access, a prescriber with one of these special waivers,” Anderson said.