Opioid (OH pee oyd) is the generic word that refers to a whole group of strong pain medicines. Examples include: hydrocodone (Norco®, Lortab®), oxycodone (Percocet®), morphine, and Dilaudid®. Opioids are an important part of the treatment for sickle cell pain. However, opioids can be dangerous and addictive if used the wrong way. They work best when used with other medicines for pain, like acetaminophen (Tylenol®) or ibuprofen (Motrin® or Advil®), and other (non-medicine treatments, like physical therapy, exercise, massage, heat, relaxation techniques, deep breathing, and distraction. There are 4 important points to remember when your child is taking opioids: Monitor, Secure, Transition, and Disposal.
- It is against the law to share or sell opioids. The sickle cell team has ordered this medicine for your child only. Do not let anyone else take this medicine.
- Addiction, abuse, and even death are all possible with opioids. They should be taken EXACTLY as prescribed. Do not change the dose or timing of opioid medicines without talking to the sickle cell team.
- Your child should not drink alcohol or take recreational drugs. Taking opioids with alcohol or drugs can cause drowsiness, slow breathing and death. Some cold medicines, cough syrups, and mouthwashes are made with alcohol. Check with the sickle cell team before giving over-the-counter medicines or herbal remedies.
- Be on the lookout for “Seekers” who are looking to steal opioid medicines. Seekers can be relatives, siblings, friends, neighbors, or strangers. Throwing away extra, unneeded, or expired opioid medicines is important because of the high risk for abuse.
- Know where the opioid medicines are at all times. Keep count of how many you have left. Ask for a new prescription at least 2 business days before you run out. Opioid medicines cannot be refilled or called in to a pharmacy. The sickle cell team needs to write a new prescription each time you run out of medicine.
- It is important to keep track of when the medicine is given. Use a calendar or the Helping Hand HH-V-1, Medication Record.
- Watch for these possible side effects:
- Constipation – Your child may need to take stool softeners or laxative medicines to prevent or treat constipation while taking opioids.
- Nausea or vomiting – Your child may need to take anti-nausea medicine.
- Drowsiness – If your child becomes drowsy or sleepy, do not let him or her ride a bike or operate machinery, like a lawnmower or car. Your child should not do any activities where he or she needs to stay alert and awake.
- Itchiness – Your child may need to take antihistamine medicine.
- Call 911 for emergency help if:
- Your child becomes very sleepy and is hard to wake up.
- Your child’s breathing slows or stops.
- Keep opioid medicines in a locked cabinet or lock box (Picture 1) and out of the reach of children.
- Keep opioid medicines in the original bottle from the pharmacy unless told otherwise by the sickle cell team.
- Ask your pharmacist for two labeled bottles if your daycare provider or school will be giving the medicine.
Transition (Off Opioids)
- It is best to take opioids along with other pain medicines, like ibuprofen (Motrin, Advil) or acetaminophen (Tylenol). Continue to take the other medicines for 1 to 2 days after stopping the opioids. This can help to keep the pain from coming back.
- Do not take acetaminophen (Tylenol) with a combination opioid that already has acetaminophen in it. Taking both together could lead to an overdose and cause liver damage.
- If opioids are taken around the clock for longer than 7 to 10 days and then are stopped all at once, it can cause withdrawal. Contact the sickle cell team if this happens. Signs of withdrawal are:
- Nausea and vomiting
- Hot and cold flashes
- Muscle aches
- Fast heart rate
- Trouble sleeping
- The sickle cell team may suggest an opioid wean. This is a gradual lowering of the opioid dose to prevent withdrawal symptoms.
- The opioids may not work as well after a while. If this happens it may be because your child is getting used to the medicine, not because the pain is getting worse. This is called tolerance. Contact the sickle cell team for advice.
- Throwing away extra, unneeded, or expired opioid medicines is important because of the high risk for abuse.
- Do not use opioid medicines after the expiration date printed on the container.
- For most patients, opioid medicines should be thrown away when they are no longer needed. For sickle cell patients:
- It is okay to keep a supply of opioid medicines in the home because sickle cell pain crises can happen at any time.
- If the opioid medicine is changed to a different medicine or dose, be sure to get rid of the old medicine.
- It is best to get rid of unused medicines at a drop box location (Picture 2).
- Visit https://www.rxdrugdrops.com/ to find a close location.
- Flushing opioids down the toilet is okay. Flush opioids if you do not have access to a drop box location and if you are concerned the medicines could be taken by a
person or pet and cause serious harm.
HH-IV-177 8/17 Copyright 2017, Nationwide Children’s Hospital