What You Need to Know About Opioid-Sparing

September 8, 2022

Table of Contents

Opioid-sparing is the practice of combining opioids with nonaddictive medications. When used together, they create an equal or comparable level of pain relief for patients with less risk of opioid related side effects, including addiction or dependence. 

How Does Opioid-Sparing Work?

Opioid-sparing is a strategy of using non-opioid medications preferentially or in conjunction with opioid medications in order to provide adequate pain relief while minimizing unnecessary risk of overusing opioid medications.[1] This can be done in the hospital setting when a patient is having acute pain, or in the outpatient setting if a patient is using opioids more long term for a chronic pain condition. 

Who Is a Candidate?

Broadly, any patient who is prescribed opioids but could see a similar level of pain relief while taking fewer opioids can be considered a candidate for opioid-sparing.

The United States is currently experiencing an opioid epidemic, with many Americans struggling with opioid use disorders. Opioid-sparing has the potential to reduce the risk that a person may develop a problem with opioids while still providing the pain relief they need. 

What Medications Are Used With Opioids With Opioid-Sparing?

There are a number of other medications that can be used either instead of or in conjunction with opioids, including anti-inflammatory medications, tylenol (acetaminophen), muscle relaxers, gabapentinoids, SNRIs, lidocaine, among others. Many of these classes of medications are relatively safe, especially compared to opioid medications. However, there are some side effects or contraindications for use. For example, patients with liver problems may not be able to use Tylenol. Patients with advanced kidney disease should not use anti-inflammatories. If you would like to minimize your risk of opioid related effects but have other health conditions that might preclude the use of other classes of opioid sparing agents, ask your doctor about which medications you can safely use. 

Opioid-Sparing Short Term Vs Long Term

Short-Term Opioid Sparing

Many patients who use opioids do so only short term to treat acute pain. For example, while hospitalized or after a surgery or procedure. Nonetheless, they may experience what are called opioid-related adverse effects (ORAEs). Short term effects of opioids include constipation, stomach distension and bloating, nausea, vomiting, itching, rashes, dizziness and alterations in mood. Therefore, opioid sparing - using other classes of analgesics such as tylenol, anti-inflammatories, muscle relaxers, etc. - can be helpful in providing supplemental pain relief and simultaneously minimizing these effects. 

Long-Term Opioid Sparing

As many as 6% of opioid-naïve (meaning people new to opioids) surgical patients become chronic opioid users once they take opioids, with the risk of long-term use rising the longer they are on opioids. Opioid-sparing has the potential to reduce these people’s risk of opioid use by having them use fewer opioids for less time while still getting adequate pain relief. For example, a patient who is using oxycodone three times a day could also try using a lower dose of the opioid and an anti-inflammatory medication at the same time, with the goal of obtaining a similar level of pain relief. 

Cannabinoids for Opioid-Sparing

One 2017 review explored the potential for cannabinoids in opioid-sparing. The results were mixed. Some evidence showed that cannabinoids may be useful for this purpose, but high-quality-controlled clinical trials recommended further exploration of the potential of cannabinoids in opioid-sparing.[2]

Other Experimental Pain Medications For Opioid Sparing

A 2017 review explored methods used to decrease opioid use postoperatively. Some drugs associated with a notable opioid-sparing effect in at least some contexts included the following:

  • Dexmedetomidine
  • Ketamine
  • Dextromethorphan
  • Gabapentinoids
  • Lidocaine

This review did note a lack of long-term outcome data, which is important for determining how effective a medication used for opioid-sparing might actually be in reducing a patient’s risk of developing an opioid use disorder long term. 

Opioid-Sparing: The Bottom Line

While opioids do have an important role in acute pain management, they always involve risk, and thus using opioid-sparing strategies is always important, when possible. There are a number of other medications that can be used either instead of or in conjunction with opioids, including anti-inflammatory medications, Tylenol (acetaminophen), muscle relaxers, gabapentinoids, SNRIs, lidocaine, among others.

If you are using opioids either short or long term and are interested in minimizing your risks, talk to your doctor about what other medications you could use either instead of, or simultaneously with, your opioids in order to control your pain but still minimize your risk of opioid related adverse effects.

Medically Reviewed By Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. Methodologies for Determining Opioid Sparing in Acute Pain Models. Pacira Pharmaceuticals, Inc. https://www.fda.gov/media/121206/download. Accessed August 2022.
  2. A Review of Opioid-Sparing Modalities in Perioperative Pain Management: Methods to Decrease Opioid Use Postoperatively. Anesthesia & Analgesia. https://journals.lww.com/anesthesia-analgesia/fulltext/2017/11000/a_review_of_opioid_sparing_modalities_in.42.aspx. November 2017. Accessed August 2022.
  3. Opioid-Sparing Effect of Cannabinoids: A Systematic Review and Meta-Analysis. Neuropsychopharmacology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5520783/. August 2017. Accessed August 2022.

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