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OUR HEALTH ADVICE – They are known to carry risks of dependence. But these pain medications retain their place when they are properly prescribed. Advice for safe use.
These are the two most prescribed opioid painkillers in France. Thus in 2022, 11.6 million French people will be given tramadol or codeine, two molecules intended to combat pain. The success of these so-called “weak” opioids undoubtedly owes much to their ease of prescription compared to “strong” opioids, such as morphine or fentanyl, which require a secure prescription to prevent falsification. But from March 2025, tramadol and codeine will also be affected by these secure prescriptions. The reason for this hardening? An increase in reports of abuse and dependence linked to inappropriate use, with sometimes dramatic consequences. Thus in 2022, tramadol and codeine were directly involved in more than 70 deaths (excluding suicidal contexts), according to the results of addictovigilance centers.
Does this mean that we must now be wary of these molecules? Should patients be concerned when they are prescribed it? No… Provided you respect the rules of good use. « These are good medicines for acute pain called nociceptive pain, and they are not dangerous provided they are well managed. », immediately reassures Dr. Maryse Lapeyre-Mestre, head of the evaluation and information center on drug dependence-addictovigilance (CEIP) in Toulouse.
Not for all pain
Pain called acute nociceptive pain results from damage to peripheral tissues which causes an excess of pain impulses. These are those caused by burns, trauma, post-operation, etc. But not all acute pain will necessarily require an opioid right away. For example, in the event of dental pain, acute lower back pain or even a sprain, they should only be prescribed if the pain is not relieved by paracetamol or a non-steroidal anti-inflammatory drug, recalls the High Health Authority. « And in pain caused by renal colic, steroidal anti-inflammatories have been shown to do better than opioids. In fact, there is not one pain but different types of pain and these medications have not been evaluated for each of them. », underlines Professor Remy Boussageon, president of the scientific council of the national college of teaching general practitioners.
Likewise, opioid medications have no place in migraines. « This is also true for medicines containing opium powder (Lamaline and Izalgi, editor’s note), widely prescribed in this indication »warns Maryse Lapeyre-Mestre. These drugs based on opium powder are not currently subject to the same regulatory measures as tramadol or codeine, but they must follow the same precautions in use.
What are the risks associated with these medications? First of all, you should know that when you take an opioid for too long, the body gets used to it and becomes less sensitive to it. « This is something that is well identified and is not easy to manage. Paradoxically, by taking an opioid long-term, your pain perception threshold decreases. So you will increase the doses », describes Maryse Lapeyre-Mestre.
When to worry about the risk of dependence?
This phenomenon does not occur when taking tramadol for around ten days, but beyond that, caution is required. This habituation will give rise to addiction, that is to say a loss of control over consumption, with a significant increase in daily doses, in search of better efficiency or intense pleasure. Habituation and dependence which pushes to increase the doses to obtain the same feeling of relief will be at the origin of accidental overdoses.
When to worry about possible addiction? “ Questions need to be asked when taking the medication for reasons other than pain. For example, to sleep better or feel more relaxed. Or when you are looking to increase doses », explains Dr. Maryse Lapeyre-Mestre. But be careful, warns the doctor, if you have been taking these medications for more than ten days and even more so for several weeks, or even several months, do not stop them overnight. « You risk having a withdrawal syndrome which can be violent. If this is the case, the risk is that you will take the medication again, which will maintain the dependence. It is therefore safer to talk to your doctor about it. », specifies Dr. Maryse Lapeyre-Mestre.
Finally, as the specialist points out, you should definitely not use this medication for pain other than that for which it was prescribed or share it with anyone close to you.
