What parents need to know about prescribed opioids for children

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Opioids are a class of drugs derived from the opium poppy plant or are synthesized (artificially made) to be similar in structure and function to the drugs from the poppy.

Common prescription opioids are codeine, oxycodone, hydrocodone, morphine, hydromorphone, fentanyl and methadone, while heroin is an illegal opioid in this country.

Opioids work by attaching to molecules found in the body that are called mu-opioid receptors. These are present in the brain, spinal cord, gut as well as other places in the body. In the nervous system, an opioid attaches to a receptor which reduces the communication of pain signals to the brain, and therefore decreases pain.

Opioids are prescribed in various forms – liquids, pills and capsules, suppositories, and through-the-skin patches. In the hospital they are typically given as an injection through an IV or into the muscle.

When prescribed for children who are outpatients, it is critically important to follow the directions given to you by the prescribing practitioner, and not giving doses that exceed their prescription, or giving the prescription more frequently than prescribed.

It is well recognized these days that addiction to opioids can occur in people.

Addiction to opioids is in fact very rare in children and is uncommon in teens, and the available scientific evidence indicates that exposure to opioids as an infant, child or teen does not increase the risk of addiction in later life.

While opioids are extremely valuable in the treatment of moderate to severe pain from many causes, they often result in side effects and complications that can be mild to severe or even fatal in severity.

Common side effects of opioids are drowsiness, nausea, itching and constipation. Less frequently they may cause severe side effects including, slowed breathing rate, extreme sleepiness, slowed heart rate, decreased blood pressure, result in loss of consciousness, and can ultimately lead to death from suppression of breathing if treatment is not started for these severe side effects.

The one side effect that is practically universal is constipation, which can occur with as little as one dose of an opioid. For this reason, we recommend that patients who are taking opioids for pain, even as little as one dose per day, take a laxative every day they are taking the opioid in order to prevent constipation, which can lead to more severe abdominal pain than the degree of pain for which the opioid was being taken in the first place!

It is widely known that opioids taken for more than a week can lead to physical dependence, and withdrawal symptoms if the opioids are abruptly or suddenly stopped.   Also over time, a patient’s body becomes accustomed to taking opioids, and this leads to a gradual increase in the dose required to achieve the desired pain relief, which is known as “tolerance.”

It is important to know that physical dependence and tolerance are not the same thing as addiction, and do not mean that addiction is occurring.

Rather, these are the body’s physical response to taking a substance over time, the body “getting used to” the substance. The same physical dependence and withdrawal symptoms will occur from many if not most medications and substances, including steroids, insulin, asthma inhalers and even caffeine.

Remember that refill prescriptions take some time and special paperwork, therefore your request for refills should not be made when you are about to run out of the prescription, but rather a few days in advance. It is also important to know that if your child has been taking opioids daily for more than a week, including time spent in the hospital, the prescription should not be stopped suddenly, but should be tapered gradually over several days to prevent the development of withdrawal symptoms (listed above).

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