Opioid (OH pee awid) is the generic word that refers to a whole group of medicines. Opioid medicines are used for pain control. They work best when used with other non-medicine treatments for pain, in combination with acetaminophen and ibuprofen. Some of these are exercise, massage, heat, ice, relaxation techniques, deep breathing, and distraction.
There are 4 important points to remember when your child is taking opioids: Monitor, Secure, Transition, and Disposal.
- There are laws that control the possession and use of opioids. Your child’s medical provider has ordered this medicine for your child only. They should be taken only as prescribed because they can be harmful and habit-forming. Do not let anyone else take this medicine.
- Know where the medicines are at all times. Keep a count of how much you have so you will always know how much is left.
- There is potential for abuse of these medicines. Opioid medicines should only be used when needed because they can be addictive. Even though this does not happen to everyone, opioid addiction can happen to anyone and can lead to permanent illness, injury and even death.
- Be on the lookout for “Seekers” – siblings, relatives, friends, neighbors, or strangers - who are looking to steal opioid medicines.
- It is important to keep a record of when the medicine is given. Use a calendar or Helping Hand HH-V-1, Medication Record.
- Possible side effects (from most common to least common):
- Constipation - It is recommended your child take medicine to help prevent or treat constipation while taking opioids.
- Nausea or vomiting - Your child may need to take medicine to help control nausea and vomiting.
- Drowsiness - If your child becomes drowsy or sleepy, do not let him or her ride a bike or operate machinery (such as a lawnmower or car), or take part in any activities where the child must stay alert and awake.
- When to call for emergency help
- Call for emergency help if:
- Your child becomes very sleepy and is difficult to awaken.
- Your child’s breathing slows or stops.
- Call for emergency help if:
- Other advice about the medicine
- Tell your child's teacher, school nurse, coach, athletic trainer, babysitter, and others that your child is taking this medicine. Tell them what side effects to watch for.
- Your child's school will need a note from you and from the doctor if the medicine is to be given at school by the school nurse.
- Your child should not drink alcohol. Taking this medicine with alcohol can cause drowsiness and inadequate breathing and can be dangerous. Some cold medicines, cough syrups and mouthwashes contain alcohol. Check with your doctor or pharmacist before giving over-the-counter medicines.
- If your child is taking any other medicine or herbal supplements, tell your doctor and pharmacist. Certain medicines should not be taken with opioids.
- Ask for a new prescription at least 3 business days before the last dose is given. This is very important.
- Some pharmacies may not have some types of opioid medicine on hand. Please ask your nurse to call your pharmacy before you leave the hospital to see if they have this medicine or can order it for you. You may also have the prescription filled at the Nationwide Children's Hospital Pharmacy.
- If your child takes too much of this medicine, or if someone else takes this medicine, call the Central Ohio Poison Center at 1-800-222-1222 (TTY 614-228-2272). They will tell you what to do.
Fact - over 10% of high school seniors reported that in their lifetime they had misused prescription opioids (pain killers).
- Keep this medicine in a locked cabinet or lock box AND out of the reach of children (Picture 1).
- Always keep medicine in the original bottle from the pharmacy.
- Ask your pharmacist for two labeled bottles if your daycare provider or school will be giving this medicine.
- Almost all opioid medicines cannot be refilled. Your child’s doctor needs to write a new prescription each time you run out of medicine and need more.
Transition (off opioids)
Get your child on the combination of acetaminophen and ibuprofen and off the opioid medicine as soon as you can. This will make it less likely your child’s body will become dependent on opioids. It is especially important for acute pain.
Using a combination of other (non-opioid) medicines and different pain management options is best. This combination helps the most with transitioning off opioid medicines.
Try the combination of acetaminophen and ibuprofen in the doses right for the age and weight of your child.
- You can use ibuprofen and acetaminophen together or alternate them.
- You can also use ibuprofen in combination with the opioid.
- Be careful using acetaminophen with the opioid. Many prescribed opioids come in a combination that has acetaminophen.
- For acute pain, you should keep giving acetaminophen and ibuprofen if your child’s healthcare provider recommends this, while cutting back on the dose and how often you give the opioid medicine.
If you find prescribed opioids are not working as well after a while, it is likely that your child is developing a tolerance to the opioids. The child is probably not having increasing pain.
The longer opioid medicines are used, the more a person’s body feels it needs them. This is called dependence.
- As one’s body gets used to these medicines, he or she needs more to control pain and chronic conditions.
- Tolerance and dependence can occur even when the medicines are used only as prescribed.
If the medicines are taken consistently for more than a week and the opioid is no longer needed for pain it should be weaned as recommended by your child’s healthcare provider.
If opioids are taken long term (longer than 7 to 10 days) and are stopped all at once, it can cause withdrawal. Signs of opioid withdrawal are:
- Hot and cold flashes
- Muscle aches
- Funny nose
- Fast heart rate
- Difficulty sleeping
- Abdominal pain
Opioid withdrawal is not life-threatening; however, it can be very uncomfortable.
If your child develops symptoms of opioid withdrawal (see above list), please contact the doctor to tell you what to do.
Fact - 70% of people who abuse prescription opioids get them free from a friend or relative. Be sure to dispose of unused medicines properly, as soon as your child’s provider tells you it is time to do so.
Do not use this medicine after the expiration date printed on the container. Opioids and other medicines should be disposed of when they are no longer needed
- Visit www.dea.gov or call DEA’s Registration Call Center at 1-800-882-9539 to find one of thefollowing:
- a nearby Drug Take-Back Event or
- a mail-back authorized collector to get a preaddressed mail-back package and instructions.
- Visit www.rxdrugdropbox.org to find out how to find a nearby collection location (Picture 2).
If you are unable to do one of the above right away, flush the medicine down the toilet. Flushing is recommended ONLY for these medicines and their brand name equivalents:
- Sodium oxybate
For patches, fold adhesive sides together before flushing (buprenorphine patches, fentanyl patches).
If you have any questions, be sure to ask your doctor, nurse, or pharmacist.
HH-IV-169 10/16 Reviewed 2/17 Copyright 2016 Nationwide Children’s Hospital