Patients and Families

It is important for patients to understand the risks, side effects, and safety issues associated with using prescription opioids as a pain treatment options. This page provides education and resources for patients and families.

Topics: Understanding Prescription Opioids | Acute Pain | Chronic Pain | Side Effects and Risks | Overdose Prevention | Opioid Addiction | Find Treatment | Non-Opioid Treatment | If You Are Prescribed Opioids | Safe Storage and Disposal | Pregnant Patients | Withdrawl and Tapering | Prescribing Guidelines and Laws | Non-Opioid Directive | Information for Medical Assistance Recipients | Resources for Caregivers | Support Groups and Self-Management Education

Opioids are natural or synthetic chemicals that relieve pain by lowering the intensity of pain signals reaching the brain. Prescription opioids are considered a controlled substance in the United States. This means they have the potential for misuse which may lead to emotional or physical dependence. The U.S. Drug Enforcement Agency assigns a schedule between one and five to every controlled substance. The lower the schedule, the greater the risk is for misuse.

• What are Prescription Opioids? (National Institute on Drug Abuse)
• List of All Controlled Substances (U.S. DEA)

Acute pain happens after an injury or surgery and gets better as your body heals. Sometimes, healthcare providers may prescribe an opioid to treat chronic pain. For acute pain, opioids are generally used 3 to 7 days or less.

• If You Recently Had an Injury (Centers for Disease Control and Prevention)
• Opioids for Acute Pain Get the Facts (Centers for Disease Control and Prevention)

Chronic pain is pain that lasts 3 months or more. It can be caused by a disease or condition, injury, medical treatment, or even an unknown reason. If you have chronic pain, it is important to understand all your options to manage pain along with the risks and benefits of each option.

• If You Have Chronic Pain (Centers for Disease Control and Prevention)
• Questions to Ask Your Doctor Before You Are Prescribed an Opioid (Food and Drug Administration)

Prescription opioids can have side effects and serious risks like physical tolerance, physical dependence, increased sensitivity to pain, addiction, and death from overdose. Opioids can be addictive even if only taken for a short time. However, serious risks are especially associated with long-term use of opioids. Learn more about possible side effects and serious risks:

• Prescription Opioid Side Effects (Centers for Disease Control and Prevention)
• Hear from people who have experienced addiction to prescription opioids (Centers for Disease Control and Prevention)

Opioids can cause bad reactions that make your breathing slow or even stop. This can happen if your body cannot handle the amount of opioids that you took or if you took a dangerous combination of opioids and other substances like alcohol, other medications, or drugs. Naloxone is a medication that can reverse an opioid overdose and is available through a state-wide standing order, which means you do not need a prescription. Most pharmacies carry naloxone.

If cost is a barrier to accessing naloxone, visit nextdistro.org/Pennsylvania to learn if you may qualify to receive free naloxone via mail.

• Preventing an Opioid Overdose (Centers for Disease Control and Prevention)
• Overdoses Involving Benzodiazepines (Centers for Disease Control and Prevention)
• Learn about the risks of counterfeit pills and what they may look like (U.S. Drug Enforcement Administration)
• Information on how to get and administer Naloxone (PA Department of Health)

People do not plan to become addicted to a prescription opioid medication. Addiction is a disease. Anyone can become addicted to prescription opioids.

• What is Addiction? (National Institute on Drug Abuse)
• If You Are Prescribed Opioids, Learn How to Reduce the Risk of Addiction (Centers for Disease Control and Prevention)
• Learn About Medications That Help Treat Opioid Addiction (Alosa Health)
  
• Learn about the science of addiction and how substance use affects the brain (Shatterproof, Just Five)
  

24/7 help is available for those battling substance use disorder. Call 1-800-662-4357 or visit the Pennsylvania Department of Drug and Alcohol Program's Website at ddap.pa.gov.

• Overview and Phases of Treatment (Help.org)
• What to Expect When Calling a Helpline (Help.org)
• Treatment works and recovery is possible. Hear stories from people who have overcome substance use disorder. (StartYourRecovery.org)

There are pain management options that may work better than opioids and have fewer risks and side effects. Learn more about ways to manage pain that do not involve prescription opioids and talk to your healthcare provider about how you can get started.

• Know Your Options (Centers for Disease Control and Prevention)
• Managing Pain, Moving Beyond Opioids (National Institute of Health)
• What Other Treatments Help with Pain? (National Institute of Health)
• Why Does Movement Help with Pain? (Oregon Pain Guidance)
• How Does Your Mood and Thoughts Affect Your Pain? (Oregon Pain Guidance)
• How Does the Food I Eat Affect My Pain? (Oregon Pain Guidance)
• How Does Sleep Affect Pain? (Oregon Pain Guidance)
• Cognitive Behavioral Therapy for Pain Management (Kaiser Permanente)

The word “complementary” refers to healthcare approaches developed outside of mainstream or conventional medicine. Most complementary approaches fall into one of two categories: 1) Mind and body practices. Mind and body practices include techniques administered or taught by a trained practitioner or teacher. Examples include acupuncture, massage therapy, meditation, and yoga. 2) Natural products. Natural products include herbs, vitamins and minerals, and probiotics. They are often sold as dietary supplements.

Complementary approaches that are safe for one person may not be safe for another based on their specific health condition or medical history. It is important to research the evidence behind complementary approaches for pain management and to talk to your healthcare provider before starting a new complementary approach. The following resources may help patients learn more about the research associated with various complementary health approaches for pain management.

• Pain: Considering Complementary Approaches E-Book (National Institute of Health, National Center for Complementary and Integrative Health)
• Pain Conditions and Current Evidence of Complementary Health Approaches (National Institute of Health, National Center for Complementary and Integrative Health)
• Resources For Your Pain Management Plan (Alosa Health)
  
• Six Things to Know When Selecting a Complementary Health Practitioner (National Institute of Health, National Center for Complementary and Integrative Health)
• Check if a massage therapist or acupuncturist is licensed by the State of Pennsylvania (Department of State) *Note, search for the individual by first and last name 
  

Patients who are prescribed opioids should work closely with their healthcare provider to create a plan on how to manage pain and learn how to safely take their medication.

• Opioid Use and Safety (PA Department of Health)
• Prevent Opioid Misuse (Centers for Disease Control and Prevention)
• How to Prepare for a Doctor's Appointment (National Institute on Aging)
• Even When Prescribed by a Doctor Opioids Carry Serious Risks (Centers for Disease Control and Prevention)

Help prevent misuse of opioids. Learn how to safely store and dispose of medications to keep others safe.

• Take action to address medicine misuse (Partnership for Drug Free Kids)
• Search for prescription drug take-back locations in your county (PA Department of Health)
• Disposal of unused medicines: what you should know (Food and Drug Administration)

Women who take opioid medication and become pregnant should talk to their healthcare provider before starting or stopping any new medications. Quickly stopping the medication can have serious risks and side effects.

• Basics About Opioid Use During Pregnancy (Centers for Disease Control and Prevention)
• Pregnancy and Opioid Pain Medications (Centers for Disease Control and Prevention)

When a patient who has been treated with a controlled substance such as opioids, benzodiazepines, buprenorphine, or stimulants, suddenly stops taking their medication, or takes less than they are used to, the patient may experience withdrawal symptoms. For example, opioid withdrawal symptoms may include anxiety, nausea, hot flashes, shivering or diarrhea. Patients at high risk of withdrawal can contact their local Single County Authority to learn more about treatment services, including options for safely managing withdrawal. A Single County Authority is a local community agency that coordinates substance use and abuse services like case management and education. Look up the Single County Authority in your county. Patients currently taking controlled substances who suddenly lose access to their prescriptions, may experience symptoms of withdrawal as soon as their first missed dose. Below are resources regarding types of controlled substances and how to find care to manage withdrawal.

Tapering means to reduce dosage over time. Tapering may be considered when a patient's medical condition, such as pain, and function are not meaningfully improving at the current dosage, the patient experiences side effects that reduce quality of life, or the patient starts to receive other medications that increase the risk for bad side effects.

• What is Tapering? (PA Department of Health)
  
• Pocket Guide: Tapering Opioids for Chronic Pain (Centers for Disease Control and Prevention)
• Guide for Appropriate Tapering or Discontinuation of Long-Term Opioid Use (U.S. Department of Health & Human Services)
• Why should I think about reducing my pain medications? (Oregon Pain Guidance)
• Benzodiazepines: Information for Patients Who Lose Access to Care (PA Department of Health)
• Opioids: Information for Patients Who Lose Access to Care (PA Department of Health) 
  
• Stimulants: Information for Patients Who Lose Access to Care (PA Department of Health) 

How do Pennsylvania Opioid Prescribing Guidelines and opioid laws impact patient care? Learn more about how the guidelines and opioid laws impact patient care.

Patients may hear their healthcare provider talk about the opioid prescribing guidelines. The Pennsylvania Department of Health, as well as the Centers for Disease Control and Prevention (CDC), developed opioid prescribing guidelines for 14 medical specialties. These guidelines, as well as the CDC guidelines, are meant for the treatment of non-cancer chronic pain patients 18 years and older.

Prescribing guidelines are based on evidence of safe and effective prescribing practices. They were created by a team consisting of medical professionals, patient advocates, community members, and representatives from various government agencies and medical associations. The purpose of the prescribing guidelines is to make sure healthcare providers provide the best care possible to patients while prescribing opioids safely and effectively. The Pennsylvania prescribing guidelines are not rules, regulations, or laws and do not stop healthcare providers from prescribing appropriately.

Patients can read more about legislation in Pennsylvania that relates to the prescribing of opioids.

• Prescription Drug Monitoring Program
• Electronic prescribing of controlled substance medications
• Opioid treatment agreements

The Pennsylvania Non-Opioid Directive is a form that patients may complete to communicate to their healthcare provider that they do not wish to be offered, supplied, prescribed, or otherwise administered any controlled substance containing an opioid. This form may be a useful tool for individuals who are in recovery to begin dialogue surrounding substance use history.

Information for Medical Assistance Recipients

The Physical HealthChoices Program is the name of Pennsylvania's mandatory managed care programs for Medical Assistance recipients. Physical HealthChoices recipients who have lost access to care and/or are looking for a new healthcare provider can call their health plan for assistance. Find contact information for your Physical HealthChoices Program.

Medicare recipients who have lost access to care and are looking for a new healthcare provider can use this online tool to search for a new provider. Search for a new provider based on your needs.

Resources for Caregivers

PA KinConnector is a program offering local financial, educational, and other supportive resources to full-time caregivers of children whose legal guardians are affected by substance use. For more information on available services please visit: Home | Kinconnector.org