Opioids can cause problems (side effects). Taking them for more than 3 days raises your chance of problems, such as:

• Trouble pooping (constipation)
• Feeling sick to your stomach (nausea)
• Vomiting
• Feeling very sleepy
• Confusion
• Not being able to stop taking the medicine
• Breathing problems

Taking opioids for a long time can make it hard for you to do daily tasks. It can also put you at risk for:

• Car accidents
• Depression
• Suicide
• Heart attack
• Taking too much of the medicine (overdose). This can lead to death.

A pain treatment plan is a plan made by you and your doctor. Work with your doctor to make a plan for treating your pain. To help you do this:

• Talk about the goals of your treatment, including:
  • How much pain you might expect to have.
  • How you will manage the pain.
• Talk about the risks and benefits of taking these medicines for your condition.
• Remember that a good treatment plan uses more than one approach and lowers the risks of side effects.
• Tell your doctor about the amount of medicines you take and about any drug or alcohol use.

Get your pain medicine prescriptions from only one doctor.

Pain can be managed with other treatments, work with your doctor to find other ways to help your pain, such as:

• Physical therapy of doing gently exercises
• Counseling
• Eating healthy foods
• Massage
• Meditation
• Other pain medicines

Taking medicine

• Take your pain medicine exactly as told by your doctor. Take it only when you need it.
  • If your pain is not too bad, you may take less medicine if your doctor allows.
  • If you have no pain, do not take the medicine unless your doctor tells you to take it.
  • If your pain is very bad, do not take more medicine than your doctor told you to take. Call your doctor to know what to do.
• Write down the times when you take your pain medicine. Look at the times before you take your next dose.
• Take other over-the-counter or prescription medicines only as told by your doctor.

Keeping yourself and others safe

• While you are taking opioids:
  • Do not drive, use machines, or power tools.
  • Do not sign important papers (legal documents)
  • Do not drink alcohol
  • Do not take sleeping pills
  • Do not take care of children by yourself
  • Do not do activities where you need to climb or be in high places, like working on a ladder
  • Do not go to a lake, river, ocean, swimming pool, or hot tub
• Keep your opioids locked up or in a place where children cannot reach them.
• Do not share your pain medicine with anyone.

Stopping your use of opioids

If you have been taking opioids for more than a few weeks, you may need to slowly decrease (taper) how much you take until you stop taking them. Doing this can lower your chance of having symptoms.

Symptoms that come from suddenly stopping the use of opioids include:

• Pain and cramping in your belly (abdomen)
• Feeling sick to your stomach (nausea)
• Sweating
• Feeling very sleepy
• Feeling restless
• Shaking you cannot control (tremors)
• Cravings for the medicine

Do not try to stop taking them by yourself. Work with your doctor to stop. Your doctor will help you take less until you are not taking the medicine at all.

Getting rid of unused pills

Do not save any pills that you did not use. Get rid of the pills by:x

• Taking them to a take-back program in your area.
• Bringing them to a pharmacy that receives unused pills.
• Flushing them down the toilet. Check the label or package insert of your medicine to see whether this is safe to do.
• Throwing them in the trash. Check the label or package insert of your medicine to see whether this is safe to do. If it is safe to throw them out:
  1. Take the pills out of their container.
  2. Put the pills into a container you can seal.
  3. Mix the pills with used coffee grounds, food scraps, dirt, or cat litter.
  4. Put this in the trash.

Activity

• Do exercises as told by your doctor.
• Avoid doing things that make your pain worse.
• Return to your normal activities as told by your doctor. Ask your doctor what activities are safe for you.

General instructions

• You may need to take these actions to prevent or treat constipation:
• Drink enough fluid to keep your pee (urine) pale yellow.
• Take over-the-counter or prescription medicines.
• Eat foods that are high in fiber. These include beans, whole grains, and fresh fruits and vegetables.
• Limit foods that are high in fat and sugar. These include fried or sweet foods.
• Keep all follow-up visits.

This condition is caused by taking opioids. Taking opioids again and again results in changes in the brain that make it hard to control opioid use. Many people develop this condition because they like the way they feel when they take opioids or because they get addicted to them.

This condition is more likely to develop in people who:

• Have a family history of opioid use disorder.
• Misuse other drugs.
• Have a mental illness, such as depression, post-traumatic stress disorder, or antisocial personality disorder.
• Begin use at an early age, such as during their teenage years.

Symptoms of this condition include:

• Taking opioids in larger amounts or for longer periods than you want to.
• Spending an abnormal amount of time getting opioids, using them, or recovering from their effects.
• Craving opioids.
• Using opioids in a way that interferes with work, school, social activities, and personal relationships.
• Giving up or cutting down on important life activities because of opioid use.
• Using opioids when it is dangerous, such as when driving a car.
• Continuing to use the drug even after it has led to problems such as:
  • Physical or mental health problems
  • Legal or financial troubles
  • Job loss
  • Broken relationships
• Being unable to slow down or stop your use of the drug.
• Needing more and more of an opioid to get the same effect (building up a tolerance).
• Experiencing unpleasant symptoms if you do not use the opioid (withdrawal). Some symptoms of withdrawal include:
  • Depression, anxiety, or feeling irritable
  • Nausea or vomiting
  • Muscle aches or spasms
  • Watery eyes
  • Trouble sleeping
  • Yawning

This condition is diagnosed based on:

• A physical exam
• Your history of opioid use
• Your symptoms. This includes:
  • How opioid use affects your life.
  • Changes in personality, behaviors, and mood.
  • Having at least two symptoms of opioid use disorder within a 12-month period.
  • Health issues related to using opioids.
• Blood or urine tests to screen for drugs.

The first goal of treatment is to stop your use of opioids. This must be done safely and may involve taking medicines to lessen withdrawal symptoms. Treatment may also involve:

• Taking part in group and individual counseling from mental health providers who have experience with substance use disorder.
• Staying at a residential treatment center for several days or weeks.
• Attending daily counseling sessions at a treatment center.
• Taking medicines as told by your health care provider that:
  • Ease symptoms and prevent complications during withdrawal.
  • Block cravings and block the good feeling that you get from using opioids.
  • Treat other mental health issues, such as depression or anxiety.
  • Reduce agitation.
• Participating in a support group to share your experience with others who are going through the same thing.
• Using opioid maintenance treatment. This involves taking certain kinds of opioid medicines. These medicines satisfy cravings but are safer than opioids that are commonly misused.

Recovery can be a long process. Some people who undergo treatment start using opioids again after stopping (relapse). If you relapse, it does not mean that treatment will not work.

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Check with your health care provider before starting any new medicines, herbs, or supplements.

General instructions

• Do not use any drugs or alcohol.
• Avoid people and activities that trigger your use of opioids.
• Learn and practice techniques for managing stress.
• Have a plan for vulnerable moments. These are times when you are most likely to relapse. Get phone numbers of those who are willing to help and who are committed to your recovery.
• Attend support groups regularly. These groups provide emotional support, advice, and guidance.
• Keep all follow-up visits. This is important. Follow-up visits include continuing to work with therapists and support groups.

This condition may be caused by:

• Taking too much of an opioid on purpose.
• Taking too much of an opioid by accident.
• Using two or more substances that contain opioids at the same time.
• Taking an opioid with a substance that affects your heart, breathing, or blood pressure. These include alcohol, tranquilizers, sleeping pills, illegal drugs, and some over-the-counter medicines.

This condition may also happen due to an error made by:

• A health care provider who prescribes a medicine.
• The pharmacist who fills the prescription.

This condition is more likely in:

• They may be attracted to colorful pills. Because of a child's small size, even a small amount of a medicine can be dangerous.
• Older people. They may be taking many different medicines. Older people may have difficulty reading labels or remembering when they last took their medicines. They may also be more sensitive to the effects of opioids.
• People with chronic medical conditions, especially heart, liver, kidney, or neurological diseases.
• People who take an opioid for a long period of time.
• People who take opioids and use illegal drugs, such as heroin, or other substances, such as alcohol.
• People who:
  • Have a history of drug or alcohol abuse.
  • Have certain mental health conditions.
  • Have a history of previous drug overdoses.
• People who take opioids that are not prescribed for them.

Symptoms of this condition depend on the type of opioid and the amount that was taken. Common symptoms include:

• Sleepiness or difficulty waking from sleep.
• Confusion
• Slurred speech
• Slowed breathing and a slow pulse (bradycardia)
• Nausea and vomiting
• Abnormally small pupils.

Signs and symptoms that require emergency treatment include:

• Cold, clammy, and pale skin
• Blue lips and fingernails
• Vomiting
• Gurgling sounds in the throat
• A pulse that is very slow or difficult to detect
• Breathing that is very irregular, slow, noisy, or difficult to detect
• Inability to respond to speech or be awakened from sleep (stupor)
• Seizures

This condition is diagnosed based on your symptoms and medical history. It is important to tell your health care provider:

• About all of the opioids that you took.
• When you took the opioids.
• Whether you were drinking alcohol or using marijuana, cocaine, or other drugs.

Your health care provider will do a physical exam. This exam may include:

• Checking and monitoring your heart rate and rhythm, breathing rate, temperature, and blood pressure.
• Measuring oxygen levels in your blood.
• Checking for abnormally small pupils.

You may also have blood tests or urine tests. You may have X-rays if you are having severe breathing problems.

This condition requires immediate medical treatment and hospitalization. Reversing the effects of the opioid is the first step in treatment. If you have a Narcan kit or naloxone, use it right away. Follow your health care provider's instructions. A friend or family member can also help you with this.

The rest of your treatment will be given in the hospital intensive care (ICU). Treatment in the hospital may include:

• Giving salts and minerals (electrolytes) along with fluids through an IV.
• Inserting a breathing tube (endotracheal tube) in your airway to help you breathe if you cannot breathe on your own or you are in danger of not being able to breathe on your own.
• Giving oxygen through a small tube under your nose.
• Passing a tube through your nose and into your stomach (nasogastric tube, or NG tube) to empty your stomach.
• Giving medicines that:
  • Increase your blood pressure.
  • Relieve nausea and vomiting.
  • Relieve abdominal pain and cramping.
  • Reverse the effects of the opioid (naloxone).
• Monitoring your heart and oxygen levels.
• Ongoing counseling and mental health support if you intentionally overdosed or used an illegal drug.

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Always ask your health care provider about possible side effects and interactions of any new medicine that you start taking.
• Keep a list of all the medicines that you take, including over-the-counter medicines. Bring this list with you to all your medical visits.

General instructions

• Drink enough fluid to keep your urine pale yellow.
• Keep all follow-up visits. This is important.

• Read the drug inserts that come with your opioid pain medicines.
• Take medicines only as told by your health care provider. Do not take more medicine than you are told. Do not take medicines more frequently than you are told.
• Do not drink alcohol or take sedatives when taking opioids.
• Do not use illegal or recreational drugs, including cocaine, ecstasy, and marijuana.
• Do not take opioid medicines that are not prescribed for vou.
• Store all medicines in safety containers that are out of the reach of children.
• Get help if you are struggling with:
  • Alcohol or drug use.
  • Depression or another mental health problem.
  • Thoughts of hurting yourself or another person.
• Keep the phone number of your local poison control center near your phone or in your mobile phone. In the U.S., the hotline of the National Poison Control Center is (800) 222-1222.
• If you were prescribed naloxone, make sure you understand how to take it.