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understand painkillers to avoid addiction.
March 17, 2018

Painkillers Explained: Understand What Medications Doctors are Prescribing for Your Pain and How They Affect You

understand painkillers to avoid addiction.When you’re dealing with chronic or acute pain as the result of an injury or illness, taking a doctor-prescribed pain medication may be unavoidable. This is where understanding what doctors are prescribing for your pain and how these medications affect you—their uses, effects and addictive qualities—can come in handy.

Doctors will usually prescribe a medication when they believe the benefits of the drug outweigh the risks. Yet when it comes to taking pain medication, the risks can be substantial, depending on the type of drug you’re prescribed. This article will educate you on types of prescription painkillers, their capacity for abuse, and their uses and effects, so that you can better understand prescription drug labels and classifications.

You’ll also get firsthand advice from Beach House Medical Director Dr. Barnell Phillips, M.D., who as an addiction-certified psychiatrist often treats patients with co-occurring substance abuse and pain issues. The end goal: helping you better advocate for safe and effective pain relief as a patient.

Understanding Prescription Drug Labels – Opiates, Opioids and Narcotics

Prescription painkillers include opioid and non-opioid medications. In terms of their potential for abuse, opioid medications present significantly greater risks of addiction. These drugs are often classified as opiates, opioids or narcotics:

  • Opiates – Opiates are naturally derived, having been extracted from the opium poppy.
  • Opioids – Opioids are synthetic or man-made replicas of opiates. These drugs are created in a lab to mimic the pain-relieving effects of opiates—sometimes with much greater potency.
  • Narcotics – Both opiate and opioid pain relievers fall into this class. The term, “narcotic,” has often been used to refer to illegal substances, and therefore increasingly has fallen into disuse. However, a narcotic is really any drug that is sleep-inducing. Because both opiates and opioids are sleep-inducing, causing drowsiness, they fall into this category of narcotics.

Narcotic Prescription Painkillers – Uses and Effects of Opiates and Opioids

Narcotic prescription painkillers are used to treat acute and chronic pain due to an illness or an injury. These medications are prescribed when a patient’s pain is more severe than what an over-the-counter drug like Ibuprofen or Tylenol can relieve. Narcotics work by binding to receptors in the brain, spinal cord and gastrointestinal tract that mediate one’s experience of pain, thereby creating a euphoric effect that relieves pain.

The effects of these drugs can vary with the drug and an individual’s tolerance, but according to a bulletin from the Mayo Clinic on treating pain, side effects can include:

  • Dizziness
  • Nausea and vomiting
  • Gastrointestinal issues
  • Cardiovascular issues
  • Sexual dysfunction
  • Fatigue
  • Mental cloudiness
  • Unclear thinking
  • Mood changes
  • Hyperalgesia (a heightened sensitivity to pain)

Understanding Narcotic Painkiller Drug Classifications

If your doctor wants to prescribe you a pain medication, take care to inquire about the drug’s classification according to the Drug Enforcement Administration (DEA) and Food and Drug Administration’s (FDA) Schedule of Controlled Substances. The Schedule of Controlled Substances (SCS) classifies drugs according to their accepted medical use and capacity for abuse.

What follows is a classification of narcotic pain medications (including opiates and opioids), according to the SCS. While the schedule has five categories (I, II, III, IV and V), commonly prescribed pain medications usually fall within the classification of Schedules II, III, or IV. (The Schedule I classification is reserved for drugs that are considered the most dangerous, with no known medical use and a very high potential for abuse; for example, heroin and marijuana.)

Schedule II drugs are considered dangerous with a high potential for abuse and dependence. To qualify for this classification, these drugs must have less than 15mg of hydrocodone per dosage unit. Here is a list of commonly prescribed Schedule II narcotic pain relief medications, which are referenced by their generic name followed by their brand name in parentheses:

  • Fentanyl (Actiq, Abstral, Duragesic, Fentora, Lazanda, Subsys)
  • Hydrocodone (Vicodin, Lortab, or Norco)
  • Hydromorphone (Dilaudid, Exalgo)
  • Meperidine (Demerol/Meperitab)
  • Methadone (Diskets, Dolophine, Methadose)
  • Morphine (brand names Kadian, MS Contin, MorphaBond, Roxanol, and others)
  • Oxycodone (Oxycontin)
  • Tapentadol (Nucynta)

Schedule III drugs have a mild to moderate potential for abuse and dependence. Painkiller meds that fall into this category have less than 90 mg of codeine (an opiate). Below is a list of commonly prescribed Schedule III narcotic pain relief medications, also referenced by their generic name followed by their brand name in parentheses:

  • Acetaminophen with codeine (Tylenol)
  • Buprenorphine (Suboxone, Subutex, Naloxone)
  • Ketamine (Ketalar)

Schedule IV drugs have a mild potential for abuse and dependence. Below is a list of commonly prescribed Schedule IV narcotic pain relief medications, also referenced by their generic name followed by their brand name in parentheses:

  • Acetaminophen and propoxyphene (Darvocet)
  • Pentazocine (Talwin)
  • Propoxyphene hydrochloride (Darvon)
  • Tramadol (ConZip, FusePaq Synapryn, Rybix ODT, Ryzolt, Ultram and Ultram ER)

Codeine is another narcotic that, depending on dosage level and how it is combined with other medications, is assigned either a Schedule III or Schedule V classification.

The above list is intended to provide you with a general introduction to the most commonly prescribed narcotic medications. For an even more detailed list, check out this helpful table from the University of Maryland.

Prescription Pain Medications That Are Safe and Effective Alternatives to Narcotics

Keep in mind that there are non-opioid prescription medications for pain that in many cases are effective alternatives. Be sure to explore these options with your doctor, if you haven’t already.

In some cases, a combination of medications may be needed, according to Dr. Phillips. He recommends a “multi-dimensional approach to pain management,” with medication being only one component of a more holistic approach. From his experience, physical therapy, massage and other alternative treatments are often useful as complementary additions to medication.

Dr. Phillips was quick to add that patients with pain issues who are considering help for an addiction to narcotic painkillers need to know that “their pain will get better.”

“We won’t give up on the treatment. We would seek out consultation from other experts if needed for complex pain situations,” he said.

If you or a loved one is struggling with pain and co-occurring substance abuse, things can get better. For more information, contact us today. You might also check out these related articles in our Learning Center: