Opioid (oh-pee-oid) medicines are used to treat severe pain.

These pain relief medicines may be used for chronic (long-term) or acute (short-term) severe pain. They work by blocking pain messages from reaching the brain. Another name for an opioid is narcotic. How long and what opioid medicine is prescribed depends on your child’s pain management plan.

Ask the care team (providers and nurses) about your child’s plan. This plan may include over-the-counter medicine or other ways such as deep breaths to relax or distract to help keep your child’s mind off the pain.

Some common opioid medicines include:

• Hydromorphone (also called Dilaudid or Exalgo)
• Morphine (also called MS Contin, Oramorph SR, Roxanol, Kadian, Embeda, MSIR)
• Oxycodone (also called Oxycontin, Roxicodone)
• Tapentadol (also called Nucynta)
• Fentanyl (also called Duragesic, Fentanyl Oralet)
• Methadone (also called Dolophine)
• Hydrocodone
• Ultram (also called Ultram)

Some medicines may be combined with acetaminophen (Tylenol) such as:

• Oxycodone with acetaminophen (also called Percocet)
• Hydrocodone with acetaminophen (also called Vicodin)

When taking these combo medicines, do not give any other medicines with acetaminophen (Tylenol). More than the safe dose of acetaminophen could cause serious liver damage.

Your child’s medicine may not be on this list or the opioid medicine may have another name. Ask your pharmacist if you have questions.

Why Is Treating / Managing Pain Important?

Pain can limit function and the ability to do everyday activities. Poor control of pain may increase the risk for other problems. Pain can also slow healing.

Pain can affect your child’s:

• Ability to cough or deep breathe
• Sleep and energy levels
• Ability to eat like normal
• Mood
• Relationships
• Activities of daily living (get dressed, brush hair/teeth, play with toys/friends, go to school/work)

Research shows that children whose pain is well controlled have fewer problems and lasting effects.

General Safety Information

Things to know before you begin taking this medicine:

Take the opioid medicine exactly as ordered.

Read the insert that comes with the medicine to learn more about the how it works and any possible side effects.

Tell your provider about other medicine your child is taking. Some medicines may need to be changed.

• Do not take over-the-counter (OTC) medicines without talking to your provider.
• Do not take the medicine unless it was prescribed for you.
• Do not share or give the medicine to anyone else.
• Do not use medicines after the expiration date on the bottle/package.
• Do not take these medicines while pregnant.

Things to know while taking this medicine:

Watch your child for serious side effects especially after the first dose. Opioids may decrease how often and deeply your child takes a breath.

Your child is at risk to fall while taking opioid medicines. Support them when they walk and crawl. Help them when going up and down the stairs. Do not climb, bike or play sports.

• Do not give this medicine if your child is too sleepy or difficult to arouse (wake up).
• Do not break, chew, crush, dissolve, or inject the medicine.
• Do not drive or operate any heavy machines, or make important decisions.
• Do not drink alcohol or use marijuana while taking this medicine.
• Do not take other medicines that sedate unless you have talked to the doctor and are told to do so.
• If you use a pain patch, keep it away from children and animals.
• For opioids prescribed for long-term use, do not stop those medicines without talking to your provider.

Keep track of (count) how much medicine you have so you know if someone else is taking the medicine.

Reduce Pain with Everyday Activities

Sometimes activities of daily living may increase pain. To limit/reduce pain and assure safety during these activities:

• Support activities allowed by provider.
• Provide a place to rest on the same level as a bathroom.
• Take short breaks as needed between activities.
• Use mobility aids if ordered by the provider.
• Encourage ways to relax such as deep and steady breaths or meditation.

Talk to your provider about ways to help your child’s activities of daily living. In some cases, physical or occupational therapy may be helpful.

Side Effects of Opioid Medicines

Side effects may include:

• Feeling sleepy
• Dizziness
• Itching
• Nausea (upset stomach), vomiting (throwing up)
• Constipation (trouble pooping), trouble peeing
• Hallucinations (not making sense when they talk)
• Slowed breathing – This is the most serious side effect; it usually occurs right after taking the opioid medicine.

Call Your Child’s Provider

Call your child's provider if:

• Your child has any unusual, long lasting, or serious side effects.
• The current medicine or amount of medicine does not reduce severe pain.

When to Call 911

Call 911 if person who took the medicine becomes

• Too sleepy or trouble waking up
• Does not respond to your voice
• Trouble breathing

Call the Drug and Poison Information Center if the person who took the drug is still awake and alert at 513-636-5111 or 1-800-222-1222

Safe Medicine Storage and Disposal

Storage

• Lock up opioid medicines in a safe place.
• Keep medicine in original package.
• Keep track of how much medicine you have. Count it.
• Always use a child-resistant cap.
• Relock the cap after each use.
• Keep the medicine away from children and animals.

Disposal

Dispose of unused opioid medicines right away. Do not save the medicine for future use. This avoids possible misuse, abuse and intake by accident.

• Visit Drugs@FDA for exact disposal of the medicine your child is taking.
• The safest way to get rid (dispose) of medicine is to drop it off at a medicine collection site. Call your local pharmacy to see if they have a medicine collection program.
• If a medicine collection program is not available:
• Use an opioid disposal kit
• Flush the unused opioid medicine down the toilet

Additional Risks of Opioid Medicines

Tolerance/Dependence

Those who take opioids for a long period of time can develop a tolerance to them. This means they may need more opioid for the same pain relief.

Withdrawal

Those who take opioids for a long period of time and suddenly stop taking these medicines may have withdrawal symptoms. This may happen after becoming tolerant or dependent.

• Symptoms of withdrawal:
• Agitation or being anxious
• Sweatiness
• Palpitations (fast heart beat)
• Shortness of breath
• Diarrhea
• Nausea (upset stomach), vomiting (throwing up)
• Goose bumps

Addiction

Long-term use of opioid medicines can be addictive. The goal of the care team is to:

• Take care of the severe pain
• Use the lowest amount of medicine that works well
• Use for the shortest amount of time

It is very rare for a child to become addicted to pain relief medicine.

It is best to talk to your provider if you have concerns about this due to the child or a family member with addiction problems.

Studies in adults (without cancer pain) have shown that opioid use for five days can increase the risk for addiction.

Opioid medicines are listed by the DEA (Drug Enforcement Agency) as controlled substances. These medicines are regulated for safety because of their side effects and risk of addiction.