Risks of opioids for sickle cell disease

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Opioids are powerful medications that can have risks of physical dependence, tolerance and addiction even if taken exactly as prescribed and without any side effects. Learn about these risks and how to work with your child's health-care team to prevent overdose.

Key points

  • Over long periods of time, daily use of opioids can create a risk of physical dependence, tolerance and addiction.
  • Physical dependence is not the same as addiction. A person will usually experience the signs of physical dependence, such as uncomfortable withdrawal symptoms, if they suddenly stop the medication.
  • Your child's health-care team will work with you to gradually stop the medication and prevent or ease withdrawal symptoms.

Opioids are powerful medications. Even if your child or teen takes them exactly as prescribed and without any side effects, they have the following risks:

If someone fails to follow the instructions on their opioid prescription, there is a risk of overdose, which can have serious consequences.

Physical dependence

Physical dependence means that your body has become used to the effects of a drug. It can occur in as little as five days if your child is taking opioids continuously or in high-dose infusions during hospital stays. On its own, it is not the same as addiction.

Your child will usually experience the signs of physical dependence only if they suddenly stop the opioid medication. The signs include uncomfortable 'withdrawal' symptoms such as irritability, shivers, sweating, nausea and stomach pain.

You and the health-care team can prevent or ease withdrawal by planning to reduce your child's dose little by little or using some other medicines to reduce the unpleasant withdrawal symptoms.


Tolerance occurs when the body needs a higher dose of a drug to get the same effect. It commonly happens if your child has been taking opioids for a long time, for example using them frequently to treat vaso-occlusive pain.

If your child is developing a tolerance to their opioid medication, their health-care team might decide to switch them to a different type of opioid.


Drug addiction is a psychological craving as well as a physical dependence on the drug. People who are addicted to opioids feel unable to stop the medication even after it starts to cause them harm.

When doctors prescribe opioids for pain, they closely control the amount and pattern of use so that they can identify early on if problems are developing.

Your child may be more at risk of developing an addiction if:

  • their prescription includes daily use
  • they or a family member has had an addiction to any substance
  • they experienced early-life trauma (neglect or emotional, physical or sexual abuse)
  • they are taking a fast-acting opioid (one that releases medication into their bloodstream quickly)

Please speak to your child's health-care team if you are concerned about your child's risk of becoming addicted or if your child notices that they are craving or misusing their medications.


An overdose means taking so much medication that your thinking and breathing slow down. Overdoses can be very dangerous, even deadly.

The risk of overdose is quite low when opioids are taken over the long term and as prescribed. Overdose risk may increase then opioids are misused.

An overdose is more likely to happen if someone:

  • takes a long-acting opioid much more frequently or in larger doses than prescribed
  • takes a large dose of an opioid along with a benzodiazepine (a medication to treat mood and sleep disorders) or other sedating medications (for example, dimenhydrinate (Gravol), diphenhydramine (Benadryl), antidepressants or gabapentin)
  • uses opioids with recreational drugs or alcohol
  • has a kidney or liver disease (these interfere with the body’s ability to eliminate the medication)
  • has a severe sleep disorder, including sleep apnea

To prevent the risk of overdosing, encourage your child or teen to:

  • be open with their health-care team about their risk factors for overdosing
  • take the medications exactly as prescribed by their health-care team
  • work with their health-care team to keep track of their medications frequently (making sure they are taking them as prescribed and that the medications are working as they should)
  • tell their health-care team about all the other medications, supplements, alcohol or other drugs that they may be taking in case there are any bad drug interactions
Last updated: January 31st 2024