Narcotic Painkillers: When They Are Needed and When They Become Dangerous
In a discussion under one of my posts on Facebook, I realized that my readers really don’t know the difference between narcotic and non-narcotic medications. Could it be that all these terrible cases of long-term narcotic drug use are caused by insufficient public awareness? A person truly thinks that since the doctor prescribed a chronic medication, they should continue taking it as long as the doctor doesn’t stop it? Please don’t ask me why the doctor didn’t stop it on time, or I’ll get stressed again, and Nehama needs to stay calm.
What are narcotic painkillers?
These are drugs containing opiates: natural (morphine, codeine), semi-synthetic (oxycodone, hydromorphone) — derivatives of the poppy plant, or synthetic — created in the laboratory, structurally different from morphine but acting on the same receptors (tramadol, Zaldiar, fentanyl, methadone).
They all act on receptors in the brain and spinal cord, blocking the transmission of pain signals. These are powerful and effective medications when used correctly.
When is prescribing opioids justified?
- Severe acute pain after surgery, trauma, or during renal or biliary colic
- Cancer-related pain
- Palliative care
How long is opioid use safe?
For acute pain — usually 1-2 weeks. After this period, the risk of developing dependence and tolerance increases sharply. The body adapts to the drug, and higher doses are needed to achieve the same effect.
Important: physical dependence does not care whether you take narcotics as prescribed by a doctor or for pleasure. It develops the same way and destroys life equally.
When is long-term use justified: palliative care
Palliative care is assistance to people with incurable or severe progressive diseases, where the goal of treatment is not to cure but to ensure a decent quality of life. In stage 4 cancer, terminal heart or respiratory failure, severe neurological diseases, a person has the right to adequate pain relief without time limits. In this context, long-term opioid use is not only acceptable but mandatory.
The doctor prescribed it but didn’t explain when to stop. What should I do?
Unfortunately, this happens. The algorithm is simple and applies to any prescription:
- Ask directly: “How many days is this prescription for? When will we review the treatment?”
- Do not automatically renew the prescription — each renewal should be a conscious decision by the doctor
- If the doctor is unavailable — consult your family doctor or a pain specialist
Lack of instructions is not permission to take the medication indefinitely.
The pain hasn’t gone away, but it’s time to stop taking the medication. What should I do?
This is the most difficult situation. The main thing is not to stop abruptly (this is dangerous!) and not to suffer in silence.
The right approach:
- Inform your doctor that the pain persists
- Request a referral to a chronic pain specialist
- Alongside tapering off opioids, explore other methods: physiotherapy, neuromodulation, pain psychotherapy, other drug classes
Chronic pain requires a comprehensive approach; a single medication rarely solves the problem completely.
What is iatrogenic addiction?
Iatrogenic means caused by treatment. This is dependence that develops not from a desire to “get high,” but because the person took a medication prescribed by a doctor and gradually found themselves trapped.
It is not the patient’s fault. It is a known complication that doctors must prevent.
Signs: the person takes the medication not to relieve pain but to avoid feeling bad without it; increases the dose on their own; cannot stop even if they want to.
What to do: urgently consult a doctor. Discontinuation is done gradually, under supervision, sometimes with supportive therapy.
Frequently Asked Questions
Is tramadol a narcotic? Yes. Tramadol is a synthetic opioid and causes physical dependence with prolonged use.
Can painkillers be taken continuously for chronic pain? Opioid painkillers are not intended for long-term treatment of chronic pain. Chronic pain requires a comprehensive approach, not constant opioid use.
How can I tell if I have developed dependence on painkillers? The main sign is that the person takes the medication not to relieve pain but to avoid feeling bad without it and cannot stop taking it on their own.
What is a chronic pain specialist? This is a physician specializing in diagnosing and treating chronic pain syndromes using a comprehensive approach — pharmacological, physiotherapeutic, and psychological.
