Professional Practice: Discerning Medication Side Effects from Symptoms and Signs

Medication Review and Review of Systems:  Side Effects of Opioid Medications

revised 3.10.2020
This is now available, with other download-able pdfs in this short online course

Keywords:  medication review, documentation standards, professional practice (OPPE), opioids, MEQ, medication side effects, workers’ comp, pain management

Why do you need to know?

It is important and useful for an EAMP to consider the side effects of a patient’s medications.  This helps when going through the assessment, including the Review of Systems (ROS), to discern what is a side effect from a medication (branch or twig) vs. what is endemic to the constitution or specific condition (root and/or earlier branch). 

What is the source of the following information?

The August 2017 CDC online training based on the January 2016 CDC Guidelines on Safe Opioid Prescribing, “Applying CDC’s Guideline for Prescribing Opioids” https://www.cdc.gov/drugoverdose/training/overview/index.html

Common Side Effects of Opioid Use

Constipation	Dry mouth
Drowsiness	Nausea
Confusion	Vomiting
Tolerance/loss of medication effectiveness	Physical dependence
Decreases ability to safely operate equipment	Sexual dysfunction

Red Flags—Be Wary of Opioid Medication + Nervous System Depressants

Benzodiazepines

Drinking alcohol

Why is this a red flag? 

These combinations [opioid + benzodiazepine or opioid + drinking alcohol] can quickly lead to respiratory depression (slowed and stopped breathing)

Serious Risks Associated with Opioid Use

Death	Opioid use disorder
Respiratory depression	Decreased ability to safely operate a vehicle
Unintentional ingestion by household members/others (children)	Overdose

What Conditions Make People at Extra High Risk for Adverse Events or Death d/t Overdose when taking Opioids, according to the 2016 CDC Guideline?

If they have a history of:	Overdose Any sleep disorders Renal or hepatic (liver) problem Alcohol or substance use problem
Age:  65+
Pregnancy (pregnant women)
If they currently have one of the following:	Depression Alcohol or substance use Prescribed over 50 MME/day Taking benzodiazepines Treated with methadone

Reference for the above information:

Source: 2016 CDC Guidelines on Safe Opioid Prescribing.  For the related CEU training, go to the CDC course, Applying CDC’s Guideline for Prescribing Opioids  

Useful Infographic when Communicating with PCM Colleagues about Non-Pharm Pain Relief Options

Moving Beyond Medications: Non-Pharm Approaches to Pain Management and Well-Being, a one-page infographic for PCMs, a collaborative work by several national Integrative Medicine groups.

Related Blogposts

Calculating Morphine Equivalent Dose (MEQ)
Metrics and Pain Management, using a Validated Pain Scale

More about sleep disturbance as a side effect of opioid medications, see Sleep disturbance in patients taking opioid medication for chronic back pain, published 2016 in the journal Anaesthesia by Robertson and Purple et al.

Biomedicine Review of Opioids

•  “2-Minute Neuroscience: Opioids” by Neuroscientifically Challenged
•  From Speed Pharmacology, published Jan. 28^th, 2019
• “Pharmacology-OPIOIDS (Made Easy)”
• From Dr. Matt & Dr. Mike YouTube Channel:
• “Analgesic Pathway: Endogenous Opioid System”, published Oct. 29^th, 2019.
• “Pain: Pathway and Analgesics (NSAIDs, Opioids, Antidepressants, and Anticonvulsants)”, published May 29^th, 2018
• “Chronic Pain and Sensitization”, published October 27^th, 2019
• “Anti-inflammatory Drugs (NSAIDs and steroids)”, published Nov. 6th, 2016
• “Prostaglandins & NSAIDs” part 1 and “Prostaglandins & NSAIDs” part 2, published April 16th, 2016
•  “Side Effects of NSAIDs”, published October 22^nd, 2019

If you found this information useful, please contribute to this resource via our website.  Thank you.

For full access to this article as a pdf plus several related pdfs, please go to our related short online course on Calculating MED: Medication Review Standard.

copyright Megan Kingsley Gale

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