Opioids: Safety and Side Effects

Toddler with hands up 

Many parents are concerned about their children being prescribed strong opioids such as morphine. Understandably, they worry about addiction and overdose specifically. However, when opioids are taken under supervision for pain relief, addiction and overdose issues are extremely rare.

Addiction

Though the drugs may be abused by some people, the experiences of a heroin abuser and a child given opioids for pain are very different. Drug addiction is a psychological craving as well as physical dependence. People who are addicted to opioids such as heroin are psychologically craving the euphoric effects of the drug rather than the pain relieving effects. Addiction requires a specific context: drug addicts are craving a "high" and nothing else; pleasure is their context. Moreover, addicts tend to take large doses and then "crash" off the drugs.

When children are given opioids to relieve pain, they are not seeking the "high" associated with the medication, they are given the medication in safe, consistent and controlled amounts, and they do not develop a psychological addiction. Generally, children look forward to reducing or stopping the medication as this indicates improvement in their pain control.

Physical dependence

Physical dependence occurs if opioids are taken for several weeks. If the medicine is suddenly stopped, an uncomfortable 'withdrawal' may occur characterized by shivering, nausea and abdominal pain. However, this can be easily prevented by easing off the medicine gradually, as the need for pain relief diminishes. Progressively smaller doses will be administered until the medication is stopped. Physical dependence should not be confused with addiction.

Tolerance

Tolerance occurs when a higher dosage of a drug is required for the same effect. This is common in drug addicts but rare when used for pain.

Overdose

Parents often worry about overdose occuring when their child is prescribed strong opioids. However, these medicines have been used for centuries and health care professionals know how to administer them with a great degree of safety. Overdose is extremely rare in children taking opioids for pain relief. If overdose does occur, it can be treated with an antidote called naloxone.

Myth: Pain-relieving drugs are too dangerous and addictive for children

Fear of addiction or overdose is often cited as a reason not to give opioids such as morphine​ to children. When appropriately given for pain relief though, these strong pain relievers are safe. Unlike substance abusers, children taking opioids for pain do not develop an addiction or psychological dependence. When the need for pain relief decreases, a gradual reduction of the medication will be used to prevent physical withdrawal. It would be cruel to withhold opioids from children in severe pain on the basis of an unfounded fear of addiction. ​​​

Michael Jeavons, MD

9/21/2009


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