Discussion Tools
Do’s and Don’ts for the Safe Use
of Prescription Opioids
Prescription opioid pain medications are an important part of the treatment of pain; however, life-threatening
side effects can occur, even in patients who are taking their opioids as directed.1 On average, 44 people
die each day from prescription opioids and over 80% of those are unintentional.2,3
Here are some important things to keep in mind when taking prescription opioids:
Take As
Directed
Take prescription
opioids only as your
healthcare provider
has prescribed1
Alcohol
Abstinence
Never drink alcohol
while taking prescription
opioids. Mixing alcohol
with opioids can cause
potentially life-threatening
adverse reactions1
Drug-to-Drug Interactions
Tell your healthcare provider about all
other medications you are taking. Serious
interactions can occur between prescription
opioids and other medications like certain
antibiotics or medicines taken for anxiety1
Be Aware
Learn the signs and
symptoms of an opioid
emergency, such as
an accidental overdose1
Tell Someone
Teach your family and
friends the signs and
symptoms of an opioid
emergency, such as an
accidental overdose, and
how to respond1
Be
Prepared
Call Your
Healthcare
Provider
Safeguard Your Medication
Lock up your prescription opioids in a safe place at all
times and dispose of unused opioids properly1,3
Talk to your healthcare
provider about naloxone
to help reverse the
life-threatening effects
of an opioid emergency
until emergency help
can arrive1
If your pain isn’t
adequately managed,
talk to your healthcare
provider. Do not take
more medicine than
has been prescribed
to you1
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Quick Facts: Prescription Opioid
Emergencies in the U.S.
What is an opioid emergency,
such as an accidental overdose?
Signs and symptoms of an accidental
opioid overdose can include:1
Prescription opioid pain medications are an important part of the
•Loss of consciousness
treatment of pain; however, life-threatening side effects can occur,
even for those who are taking their prescription opioids as directed.6
An opioid emergency, such as an opioid overdose, is characterized
by breathing that slows to a dangerous rate or even stops. Small
changes – such as an extra dose or the consumption of alcohol – can
•Very slow or absent breathing
•Extremely small pupils
•Slow or irregular heartbeat
• Blue or purple fingernails or lips
result in a potentially life-threatening opioid emergency.7
What to do during an accidental
opioid overdose:
Opioids work by binding to specific receptors in the brain, minimizing
Seconds count during an accidental opioid
the body’s perception of pain. During an opioid emergency, a person’s
heart rate can slow down and they have a decreased drive to breathe.1
According to the FDA, respiratory depression is the most important serious
adverse effect of opioids as it can be immediately life-threatening.
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overdose; opioids can cause a patient’s
breathing to slow down or even stop and,
without intervention, lack of oxygen can lead
to brain injury in as little as 4 minutes. If you
witness someone exhibiting these symptoms,
call 9-1-1 or seek emergency medical help
Risk factors for an accidental opioid overdose include:
•History of certain medical conditions such as chronic respiratory
disease and diseases that interfere with the metabolism or
elimination of an opioid from the body9
•Taking high doses of prescription opioids, extended-release or
long-acting opioid formulations7
•No previous history of taking opioids
immediately after giving naloxone.13
People managing pain with the help of opioids
should talk to their healthcare provider about
having naloxone in the home as encouraged by
the American Medical Association for patients
who are at risk so that friends, family members
or caregivers can rapidly intervene in the event
of an opioid emergency.5
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•A recent dosage increase or switching from one opioid to another9
•History of substance abuse or dependence1
Department visits each year14
•Taking certain medications or substances that can interact with an
opioid, including alcohol, certain antibiotics (e.g., erythromycin), or
medicines for anxiety (e.g., benzodiazepines)11
•Children living with someone consuming prescription opioids who
may be accidentally exposed to opioids12
~136,000 opioid overdose Emergency
Up to 60% of opioid overdose deaths occur
in individuals without a previous history of
substance abuse15
≥16,000 people died in 2013 from opioid
overdose – about 44 people each day16
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Discussion Guide: Talking to
Your Healthcare Provider
Accidents with prescription opioids can happen to anyone taking them. Print this discussion
guide and take it with you to your next appointment with your healthcare provider to get the
conversation started.
As a person living with pain, you’ve likely talked
with your healthcare provider about your pain
management plan, opioid medications and long-term
health goals. Prescription opioid pain medication
remains an important part of the treatment of pain;
however, the side effects associated with their
use may be serious and in some cases can be
life-threatening.1 These side effects can be difficult
•
How
does an opioid emergency, such as an accidental
overdose, occur?
What kinds of things should I be doing to make sure
I’m taking my opioid safely?
Can an opioid emergency still occur even if I take my
prescription opioid as directed?
to control, even for those taking their opioids
as directed.6
Do you have the most recent information about the
side effects and safety precautions to be aware of
when taking prescription opioids? Have you asked
how you can best prepare for an opioid emergency,
such as an accidental overdose?
Are there any factors that may increase the chance of an
opioid emergency that could cause my breathing to slow
down or even stop?
What are the signs and symptoms of an opioid emergency?
What is naloxone and how is it used during an
opioid emergency?
What should I make sure my family members and/or
friends are aware of in case an opioid emergency occurs?
About
Naloxone
Naloxone is a prescription medicine used for the treatment of an opioid emergency, such as
an accidental overdose with signs of breathing problems and severe sleepiness or not being able
to respond. Naloxone is to be given right away by a caregiver and does not take the place of
emergency medical care.1 Get emergency medical help right away after the first dose of naloxone,
even if the person wakes up. Multiple professional organizations, including the American Medical
Association, encourage co-prescribing naloxone to at-risk patients who are taking opioids.5
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Discussion Guide: Talking to
Family Members and Friends
Have you talked with family members and friends about the safe use of opioids and their
potential side effects? Have you discussed how to prepare for and respond to an opioid
emergency, such as an accidental overdose?
If you’ve been prescribed opioids, it’s important to keep those closest to you informed and involved.
Following are some discussion topics to help you talk with family and friends about prescription opioids
and the potential side effects associated with these medications.6 Print this guide to help support a
conversation with those closest to you.
What is an opioid?
I am currently taking a strong prescription pain medicine
known as an “opioid.” It helps relieve my severe pain
when other pain treatments are not enough, better
allowing me to go about my daily activities. Here is a list
of the opioid medications that I’m currently taking and
their dosages:
––––––––––––––––––––––––––––––––––––––––––––––
There can be side effects associated with taking
a prescription opioid
Even though I take my medication as directed and follow
the instructions from my healthcare provider, side effects
can still occur.
[If applicable] Here’s a list of other medications that I
am currently taking, as well as other health conditions
that I have:
––––––––––––––––––––––––––––––––––––––––––––––
––––––––––––––––––––––––––––––––––––––––––––––
––––––––––––––––––––––––––––––––––––––––––––––
––––––––––––––––––––––––––––––––––––––––––––––
––––––––––––––––––––––––––––––––––––––––––––––
––––––––––––––––––––––––––––––––––––––––––––––
––––––––––––––––––––––––––––––––––––––––––––––
––––––––––––––––––––––––––––––––––––––––––––––
These are my healthcare providers’ names and
phone numbers:
––––––––––––––––––––––––––––––––––––––––––––––
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While prescription opioids can be very effective,
like all medications, they have side effects.
Some side effects may be mild, while others may
even be life-threatening, including causing your
breathing to slow down or even stop.1
––––––––––––––––––––––––––––––––––––––––––––––
If someone is having an opioid emergency — even if you’re not quite sure —
immediately administer naloxone and call 9-1-1 or seek emergency medical help.1
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Discussion Guide: Talking to
Family Members and Friends
Even when taking a prescription opioid as directed, an
opioid emergency, such as an accidental overdose may
occur: small changes – like an accidental extra dose or
the consumption of alcohol – can result in a potentially
life-threatening opioid emergency.1,6
Other factors that could increase the chance
of a life-threatening opioid emergency include:
•Medical conditions such as chronic respiratory
disease and other illnesses that affect the way you
metabolize an opioid 9
•Taking medications or substances that can interact
with an opioid, including alcohol, certain antibiotics
(e.g., erythromycin), or medicines for anxiety (e.g.,
benzodiazepines)11
An opioid emergency can cause serious side effects,
including not being able to breathe.1 Unconsciousness
generally happens before breathing slows down. An
opioid emergency can also lead to brain injury, coma or
even death. Even people without medical training
can learn to identify an opioid emergency.12
Common signs and symptoms include:1
•Breathing problems, from slow or shallow
breathing to not breathing at all
•Not being able to wake the person up
•Very small pupils
• Extreme or unusual sleepiness
•Taking high doses of opioids, extended-release or
long-acting opioid formulations6
•No previous history of taking opioids, a recent dose
increase or switching from one opioid to another10
It’s important to be prepared to recognize and
respond to an opioid emergency
My opioid safety plan includes:
–––––––––––––––––––––––––––––––––––––––––––––––––
–––––––––––––––––––––––––––––––––––––––––––––––––
Seconds count during an accidental overdose
[If applicable] I have a prescription for naloxone as part of
my opioid safety plan. Naloxone is a prescription medicine
used for the treatment of an opioid emergency, such as an
accidental overdose with signs of breathing problems and
severe sleepiness or not being able to respond. This is where
I keep it in the event of an opioid emergency:
–––––––––––––––––––––––––––––––––––––––––––––––––
–––––––––––––––––––––––––––––––––––––––––––––––––
SECONDS COUNT
–––––––––––––––––––––––––––––––––––––––––––––––––
There are approximately
136,000 opioid
overdose Emergency Department visits each year14
3,300
On average, approximately
children 0-5
years old are admitted to the Emergency Department
each year due to accidental opioid exposure12
Seconds count during an accidental overdose since it
can cause breathing to slow or stop. Without immediate
help, lack of oxygen can lead to brain injury in as little
as 4 minutes.13 The American Medical Association
encourages at-risk patients to talk to their healthcare
providers about having naloxone, an opioid antidote, in
the home so that family members or friends can quickly
intervene in the event of an opioid emergency.5
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References
1
SAMHSA Opioid Overdose Prevention Toolkit Safety Advice for Patients. HHS Publication No. (SMA) 13-4742.
Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. Vital Signs Fact Sheet. Available at: http://www.
cdc.gov/vitalsigns/opioid-prescribing. Accessed May 2015.
2
Tennessee Department of Health. Available at: http://health.state.tn.us/MCH/PDFs/VIPP/Drug%20Overdose%20Deaths%202012%20
Report.pdf. Accessed May 2015.
3
Pain Treatment Topics. Opioids911-Safety. Available at: http://opioids911.org/media/pdf/Op911-PatientInstructions.pdf. Accessed May 2015.
4
Harris, P. (2015, June 29). It’s about saving lives: Increasing access to naloxone. Accessed July 10, 2015, https://www.ama-assn.org/
ama/ama-wire/post/its-saving-lives-increasing-access-naloxone.
5
6
Bohnert A, et al. JAMA. 2011;305:1315-1321.
7
Boyer EW. Management of Opioid Analgesic Overdose. N Engl J Med. 2012;367:146-155.
8
Food and Drug Administration. Blueprint for Prescriber Education for Extended-Release and Long-Acting Opioid Analgesics, 2014.
9
Leavitt, S. Intranasal Naloxone for At-Home Opioid Rescue. Practical Pain Management. Oct 2013.
10
Manchikanti, L. Opioid Epidemic in the United States. Pain Physician. 2012;15;ES9-ES38.
Gudin JA, Mogali S, Jones JD, Comer SD. Risks, Management, and Monitoring of Combination Opioid, Benzodiazepines, and/or Alcohol
Use. Postgrad Med. 2013 July; 125(4): 115–130.
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12
Burghardt LC. Adult Prescription Drug Use and Pediatric Medication Exposures and Poisonings. Pediatrics. 2013; 132: 18-27.
Mount Sinai. Anoxic Brain Damage. http://www.mountsinai.org/patient- care/health-library/ diseases-and-conditions/anoxic-brain-damage.
Accessed December 22, 2014.
13
Yokell et al. Presentation of Prescription and Nonprescription Opioid Overdoses to US Emergency Departments. JAMA Intern Med.
2014;174(12):2034-2037.
14
15
Siegler A. Int J Drug Policy. 2014 May;25(3):569-74. doi: 10.1016/j.drugpo.2013.10.015.Epub 2013 Nov 8.
16
Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report. Vol. 64. No. 1. Pg. 32. January 16, 2015.
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