When Are Opioids Appropriate?

Opioids are a class of drugs reserved for the treatment of significant pain that does not respond to other therapies. A physician may prescribe opioids:

  1. For postsurgical pain, such as joint replacement, spine surgery, or gallbladder surgery.
  2. After a severe, acute injury such as a broken leg.
  3. As part of a larger treatment plan for people with chronic pain. Opioids have been proven successful when used in combination with non-opioid medication and other treatments. Opioids are rarely taken alone for chronic pain.

See Understanding Chronic Pain: The Gate Control Theory

Opioids, like all drugs, should be taken only when necessary and as directed by a physician. Generally, opioids are safest and most effective when taken short-term for moderate to severe pain. They should not be mixed with alcohol, illegal drugs, or certain other medications, such as sleep aids.

See How Opioids Work in the Brain

This article focuses on when opioids are prescribed, the different kinds available, how they work, and their potential risks, complications and side effects.


Postsurgical Pain and Opioids

Most patients would experience significant pain during the hours and days after surgery without postsurgical pain control. Postsurgical pain control often includes opioids. Fluid opioid medication may be administered through an IV while in the hospital. Oral opioid medications may be prescribed for use during outpatient recovery.

Some surgeries, such as back surgery and joint replacement, may be scheduled for patients who are already taking opioids for chronic pain. In these cases, the patient may be asked to wean off or taper opioid use. Doing so makes postsurgical pain easier to control and leads to better recovery outcomes.

Many hospitals, and even states, have implemented guidelines regarding the prescription of postsurgical opioids in order to reduce the risk of abuse and addiction.

Acute Injury Pain and Opioids

Nearly 43% of emergency room visits are related to pain, and many of those visits stem from injuries.1 A severe acute injury can cause pain significant enough to require opioids.

Many acute injuries, such as bone fractures, require visits to an emergency department. Because of this, many hospitals have opioid prescribing guidelines that require doctors to obtain patients’ medical backgrounds and personal information quickly.

The doctor will likely assess the patient for certain criteria:

  • Evaluate medical history for conditions such as pulmonary disease or sleep apnea.
  • Look for patients with a history of substance abuse or family history of addiction.
  • Determine if the person is opioid naïve, or is currently taking opioids for another condition, such as chronic pain.
  • View prescription history of controlled substances usage as verified by the state’s Prescription Drug Monitoring Program (PDMP).

What the doctor asks and looks for will vary from person to person and hospital to hospital.


Chronic Pain and Opioids

Opioids can be prescribed as part of a comprehensive, patient-centered pain management program that involves physical (biological), psychological, and social aspects of chronic pain. This biopsychosocial approach to chronic pain management program will consider:

  • The disease or illness causing pain
  • Mental health, including personality and overall behavior
  • Socioeconomic, cultural and familial aspects

See Applying Gate Control Theory to Pain Relief

By treating the whole person, chronic pain can be addressed from multiple angles and quality of life can be improved.

The Center for Disease Control (CDC) recommends nonopioid therapy as the preferred treatment for chronic pain, however, opioids can be prescribed when the benefits of pain relief and function outweigh the risks. A pain management specialist is best equipped to make these decisions.

Prescribing opioids for chronic pain has long been debated in the medical community and more long-term studies are needed.


  • 1.Broida RI, Gronowski T, Kalnow AF, Little AG, Lloyd CM. State Emergency Department Opioid Guidelines: Current Status. West J Emerg Med. 2017;18(3):34
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