When contractor Nicholas Severais, 58, of San Mateo, Calif., fell off a roof several years ago and broke one of his vertebrae, he was put on a whole slew of opioids during the course of his treatment. They alleviated the pain but brought other challenges.
"I got nightmares and hallucinations from the morphine. And with that, and the codeine, I also got long-term constipation," he remembers.
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"Your whole life becomes this kind of tightwire balancing act between 'How many painkillers did I take today?' and 'Should I or shouldn't I take one of these?' You get into these patterns where you're taking all these pills to counteract the pills that you are already taking."
Roger Chou, MD, an associate professor of medicine at Oregon Health and Science University, says that although constipation will be a problem as long as you're on the medication (the drug slows down your gut), other side effects do seem to diminish with time.
"The sedation, or sleepiness, usually gets better as people are on the medication longer, as does the nausea. But some people just can't stay on it, because they can't take being sedated or nauseated for two or three weeks."
Aside from oral dosages, opioids can be taken many ways, including by rectal suppository, intravenous injection, under-skin implantation, skin patch, or even injection into a region around the spinal cord. Some opioids give relief for just a few hours, though controlled-release formulations, such as that found in OxyContin, can provide pain relief for much longer. (A fentanyl patch can give pain relief for up to 72 hours.)
Though these drugs can bring great relief to chronic pain patients, scandals surrounding them have led to the prosecution of doctors who prescribe them inappropriately. And that can make it more difficult for legitimate pain patients who need the relief of opioids to get access to them.
