Frequently Asked Questions

An opioid is a class of drug used to reduce moderate to severe pain. Opioids include pain relievers available by prescription such as oxycodone, hydrocodone, codeine, morphine and fentanyl. The illegal drug heroin is also an opioid.

Prescription opioids can help manage pain when prescribed for the right condition and when used properly by the patient. Common side effects of opioids include drowsiness, dizziness, nausea, vomiting, constipation, and slowed or difficult breathing. Regular use of opioids—even as prescribed by a doctor—can lead to dependence. When misused or abused, opioids can cause serious harm including addiction, overdose and death.

Opioids bind to receptors in the brain which then produce dopamine, triggering sensations of pain relief, pleasure and euphoria. Studies show that chronic use of opioids actually changes the brain creating opioid dependence - a need to keep taking drugs to avoid withdrawal symptoms - and addiction - an intense drug craving.

The first sign of an opiate addiction is that the person’s original medication or dosage is no longer adequate to deal with the pain. Because of this, they may ask their doctor for a stronger medication or a dosage increase.

The issue with an opioid addiction is that the brain believes it needs opiates in order to feel well. As a result, the brain will actually make pain seem more intense than it is. In turn, a person feels they need stronger medications to deal with their pain. The risk of overdose on an opioid grows the longer a person uses the drug because they develop a tolerance for the painkilling effects but not the overdose causes.

Because heroin is so closely related to prescription opioids, the abuse of or addiction to prescription painkillers is often a first step to eventual heroin addiction.

All opioids work similarly. Sensory information, such as temperature or pressure, is transmitted from the body along nerves to the spinal cord and, from there, to the brain.

The National Institute on Drug Abuse explains that opioids affect more than the brain. They also affect:

• The limbic system, which controls emotions
• The brainstem, which controls automatic functions like breathing
• The spinal cord, which controls pain transmission

For a more complete explanation of how opioids work in the body and brain watch The Science of Opioids by Healthcare Triage.

Benzodiazepines (also called benzos) are man-made medications that depress the nerves within the brain and also cause drowsiness. Diseases that require benzodiazepine may be caused by excessive activity of nerves in the brain. Some of the conditions that doctors treat with benzodiazepines include:

• Anxiety
• Nervousness
• Panic disorders
• Muscle spasms
• Seizures
• Sleeplessness
• Alcohol withdrawal

Benzodiazepines are habit forming and can lead to addiction. Like opioids, long-term use can lead to tolerance, which means that lower doses will become ineffective and patients will need higher doses in order to get the same results. Common side effects of benzodiazepines include drowsiness, dizziness, weakness, and physical dependence.

Common benzodiazepines include:

No, but it is so dangerous that both the U.S Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention have issued warnings about prescribing the two drugs together.

A 2017 study showed that people concurrently using both drugs are at higher risk of visiting the emergency room or being admitted to a hospital for a drug-related emergency. In addition, a report from the CDC Mortality and Morbidity Weekly published in August 2018 showed that over 50% of prescription opioid deaths also involved a benzodiazepine. That is up from the 30% previously reported.

In a 2016 Drug Safety Communication regarding the use of opioids with benzodiazepines the FDA stated, “The growing combined use of opioid medicines with benzodiazepines or other drugs that depress the central nervous system (CNS) has resulted in serious side effects, including slowed or difficult breathing and deaths. In an effort to decrease the use of opioids and benzodiazepines, or opioids and other CNS depressants, together, we are adding Boxed Warnings, our strongest warnings, to the drug labeling of prescription opioid pain and prescription opioid cough medicines, and benzodiazepines.” At the same time, the FDA made revisions to the Warnings and Precautions, Drug Interactions, and Patient Counseling Information sections of the labeling. The CDC also warns about prescribing the two drugs together saying, “Whenever possible, avoid prescribing opioids and benzodiazepines concurrently. Communicate with other prescribers to prioritize patient goals and weigh risks of concurrent opioid and benzodiazepine use.”

Acute pain generally comes on suddenly and is caused by something specific such as a traumatic injury, a broken bone, a pulled muscle or surgery. Once the injury heals, the pain subsides. Acute pain usually does not last longer than six months.

Chronic pain is ongoing and usually lasts longer than six months. This type of pain can continue even after the injury or illness that caused it has healed. Pain signals remain active in the nervous system for weeks, months, or years. Chronic pain is linked to conditions including but not limited to:

• Headache
• Arthritis
• Cancer
• Back pain

People who have chronic pain can suffer physical effects that are stressful on the body. These include tense muscles, limited ability to move around, a lack of energy, and appetite changes. Emotional effects of chronic pain include depression, anger, anxiety, and fear of re-injury. Such a fear might limit a person's ability to return to their regular work or leisure activities.

Multiple research studies suggest that opioid abuse opens the door to heroin use. According to the CDC, 75 percent of new heroin users are coming to heroin after abusing prescription opioids. The switch to heroin is driven by several factors including:

• Heroin being cheaper and easier to obtain than prescription opioids
• The purity of heroin available at the retail level

Prescription Drug Monitoring Program

A PDMP is a statewide electronic database that tracks all controlled substance prescriptions. PDMPs collect, monitor, and analyze electronically transmitted prescribing and dispensing data submitted by pharmacies and dispensing practitioners. Forty-nine states, the District of Columbia and the U.S Territory of Guam have a PDMP.

A PDMP serves as a tool for addressing:

• Patient care
• Drug abuse prevention
• Drug diversion
• Potential drug epidemics
• Insurance fraud
• Education
• Research

PDMPs do not interfere with appropriate medical use and do not infringe on the legitimate prescribing of a controlled substance by medical practitioners. Prescribers who use the database can learn the extent to which controlled substances have been dispensed to a patient and whether other providers have prescribed similar drugs during the same period. Improving the way opioids are prescribed will ensure patients have access to safer, more effective chronic pain treatment while reducing opioid misuse, abuse, and overdose.

The Colorado State Board of Pharmacy oversees the PDMP and requires the reporting of Scheduled II-V drugs. Every prescription drug outlet must ensure that all controlled substance dispensing transactions are reported to the PDMP on a daily basis by no later than the outlet’s next regular business day.

The U.S. Drug Enforcement Agency (DEA) arranges potentially-harmful medications such as opioids into groups called Schedules. The higher the risk of abuse in each Schedule, the more strict the regulations are surrounding its prescription and use.

Opioids are Schedule II drugs and are defined as drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence. These drugs are also considered dangerous. Some examples of Schedule II drugs are:

• Hydrocodone
• Oxycodone
• Hydromorphone
• Meperidine
• Methadone
• Fentanyl

Naloxone is a medication designed to rapidly reverse opioid overdose. It is an opioid antagonist—meaning that it binds to opioid receptors and can reverse and block the effects of other opioids. It can very quickly restore normal respiration to a person whose breathing has slowed or stopped as a result of overdosing with prescription opioid pain medications or heroin.

Naloxone comes in three forms:

• Injectable
• Autoinjectable
• Nasal Spray

Colorado law allows anyone to get and administer naloxone in order to help some who may have overdosed. It can be obtained:

• At a pharmacy without a prescription
• By prescription from a health care provider
• At a harm reduction organization

Colorado's Good Samaritan Law encourages witnesses or victims to call for medical help during emergency overdose situations. It provides limited legal protection from drug charges for those who call 911 for help and along with third party laws protects individuals who administer naloxone from liability.

For more information visit www.prescribetoprevent.org

The Colorado Consortium for Prescription Drug Abuse Prevention, which was created in 2013, coordinates Colorado’s response to the misuse of medications such as opioids, stimulants, and sedatives. The Consortium’s mission is to reduce prescription drug misuse and abuse in Colorado by developing policies, programs, and partnerships with the many Colorado agencies, organizations, and community coalitions addressing one of the state’s major public health crises.

The Consortium works with state and federal agencies and task forces, nonprofit organizations, health care providers, public health officials, and other groups that address the prescription drug abuse problem to improve education, public outreach, research, safe disposal, and treatment. The Consortium also advises policymakers on legislation and programming that can be implemented to address the crisis.

The Consortium has nine workgroups each focused on various aspects of the epidemic. Each of those groups is co-chaired by volunteers from partner organizations. Members of the JP Opioid Interaction Awareness Alliance’s board of directors sit on several Consortium work groups.

The JP Opioid Interaction Awareness Alliance welcomes individuals who have been affected by the opioid epidemic. We need volunteers to help with our events and who are willing to tell their stories in public settings. For more information, visit the Volunteer Info page.