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School of Medicine
Prescribed a Painkiller? If It’s an Opioid, Read This First
Maybe you’ve been dealing with chronic pain for a long time. Maybe you’re recovering from surgery and you need short-term pain relief. Whatever the case, you may find yourself with a modern dilemma: whether or not to take prescription pain medication.
Most of the commonly prescribed drugs in this category contain opioids, a class of highly effective but highly addictive pain relievers — which includes oxycodone, codeine and morphine. Although opioids have their place in pain control, they can easily be misused, and this misuse is at the heart of the drug epidemic sweeping the nation.
It’s easy to dismiss the problem as something that could never happen to you, but opioid overdose is now the leading cause of accidental death for Americans. And it’s a problem that’s worse if you’re female: Women are at increased risk of becoming dependent on or addicted to opioids. Additionally, while the death rate from prescription drug overdoses dramatically increased overall from 1999 to 2010, it rose 400 percent in women compared to 265 percent in men.
Why is this happening? There are multiple reasons why women are quickly becoming the face of the opioid crisis, says Alexis Hammond, M.D., Ph.D., a psychiatrist in the Department of Psychiatry and Behavioral Sciences at Johns Hopkins Medicine.
More Women Are in Pain
“Women are prescribed pain relievers more often than men,” says Hammond, who also sees patients at the Center for Addiction and Pregnancy at Johns Hopkins Bayview Medical Center. “Part of that has to do with women tending to have lower pain tolerance in general and being more likely to experience chronic pain conditions.”
Women suffer from migraine headaches and neck, facial and lower back pain at up to twice the rate men do. In addition, women are more likely to develop conditions that cause chronic pain. For example, women are three times more likely to develop rheumatoid arthritis and four to seven times more likely to develop fibromyalgia than men are.
“Another component of women being on higher doses of painkillers and using them for a longer period of time has to do with our culture,” explains Hammond. “Unfortunately, it has historically been more socially acceptable for women to ask for help, while men may feel they have to just grin and bear it.”
From Pain Relief to Addiction and Overdose
Once women start taking prescription opioids, they may become dependent on them more quickly than men. Additionally, women are more likely to have depression and anxiety than men and may use opioids as a way to self-medicate a mood disorder.
Some studies, says Hammond, are raising concerns about one more way opioids may be hooking people: The research indicates that long-term opioid use may produce changes in the brain that can make you more susceptible to experiencing pain. That, in turn, makes you want more painkillers.
Even worse? Many people with an opioid addiction eventually turn to heroin, an opioid that’s cheaper to buy on the street than illegal prescription drugs. Although you might think of heroin as a street drug and not related to prescription medications, four out of five new heroin users first became addicted to prescription painkillers.
Heroin is not dangerous simply because it’s a street drug. “Often, heroin is mixed with fentanyl, which is a very strong opioid and has led to a lot of overdose deaths,” says Hammond. “Using street drugs is so dangerous because you don’t know what’s in them.”
But you don’t have to be on heroin to overdose. You can accidentally overdose if you’re taking a mix of prescriptions or if you drink alcohol while taking opioids, explains Hammond. If you’re taking more than one prescription medication, check with your doctor to see if the drugs have any dangerous interactions.
Signs of Opioid Dependence and Misuse
Opioid dependence is a term used to describe the way your body adapts and begins needing opioids to avoid negative effects. “If you find that you’re taking medication more frequently than prescribed — say every four hours instead of six — or need frequent refills or your pain is not well-managed, you should talk to your doctor,” says Hammond. Your body could be developing a tolerance to the drug, which makes you need more medication to achieve the same pain relief.
Another sign of opioid dependence is experiencing withdrawal symptoms in the absence of medication, such as:
- Agitation and anxiety
- Muscle aches
- Abdominal cramping and diarrhea
- Nausea and vomiting
Misuse typically refers to behavior associated with drug use. If you find you’re using prescription opioids for the feeling it gives you (the “high”) instead of pain control, that’s a sign of an opioid use disorder, or addiction. If you can’t stop using the drugs despite negative consequences at work, school and home, that’s also a clear sign of a problem.
Taking an opioid to relieve pain isn’t your only option. Ask your doctor about other types of medications that can ease pain such as non-steroidal anti-inflammatory drugs (NSAIDs) like naproxen. Even some antidepressants, such as duloxetine, may work well to control chronic pain, Hammond says. Besides medications, you can also try physical therapy, massage therapy, heating pads, acupuncture and lifestyle changes such as increasing exercise and losing weight.
“As doctors, we want your pain to be well-controlled, but we also want to make sure we’re not getting to the point of misusing opioids,” says Hammond. “Some people may do well on long-term opioids. But for most people, there are other medications that are better for chronic pain.”
If you think you are misusing opioids or have become dependent on them, talk to your doctor about appropriate next steps. You can also learn more about our addiction treatment services or explore our opioid resources site for further information on opioids, the science of addiction, and how to prevent and treat opioid dependence.