The Food and Drug Administration just announced its goal of lowering the amount of nicotine in cigarettes, in hopes of helping people to quit.

The theory is that with less nicotine, there is potentially less dependence. The cravings of habitual smokers might just weaken if they get less nicotine per cigarette.

Only time will tell if this will actually reduce smoking rates, but it’s definitely a novel idea.

What if same approach was applied to opioid medications?

Oxycodone pills

When opioids are needed, we be prescribing smaller doses.


Currently, many of the commonly prescribed medicines are combined with other ingredients, like acetaminophen. Doses of the opioid ingredients start low at 5 or 10 milligrams, but even with these low dose pills, there is the potential for overdose when given to the elderly or in combination with with other medications.

Cutting the amount of active opioid in the most commonly used pills could be done the same way nicotine is being decreased in cigarettes.

It’s not a completely new concept. A few years back, the strength of recommended doses of acetaminophen was reduced when it became clear that taking three or more doses could lead to significant liver toxicity. Regular-strength dosing of 300-325 milligrams replaced prior amounts of 650 milligrams of acetaminophen to reduce the risk of liver damage.

Starting at even lower doses can help those who are using the medication for post-surgical pain avoid becoming addicted to the pills.

If lower doses are used at the onset, the level of dependence leading to addiction might decrease.

Starting with a standard dose of only 2.5 milligrams of hydrocodone, instead of the usual 5 milligrams, might also reduce potential side effects: constipation, inability to urinate, dizziness and nausea, just to name a few.

Studies have shown that after surgery, 67 to 92 percent of patients end up with too much leftover pain medicine, and few safely store the remaining pills. Fewer pills can be prescribed, but lower doses might also provide the same relief without the extras.

Lower doses could also eliminate the need to cut pills in half, making it easier for seniors or those who have arthritis.

As with nicotine, the reduction in dose is meant to help people slowly reduce the amount of exposure to the substance on a daily basis.

Another major area of concern is the long-acting opioid medication taken every six to eight hours that is usually prescribed in much higher doses than the short-acting pain pills.

Long-acting, high-dose formulations of pain medications need modification. Oxycontin, seen as an answer to the frequent need to take short-acting medication, is now one of the most abused medications in the U.S.

The doses range from 10 to 160 milligrams, potentially providing a false sense of security for those who are on the lower range, thinking chronic use is okay. But a tolerance develops over time, and there is an almost inevitable dose escalation with continued use. 

Longer-acting opioids work — often too well — and as the strength of the pills goes up, so does the risk for respiratory depression. It starts with falling asleep, then not breathing, leading to possible death.

You can get addicted to opioids much faster than nicotine. With chronic pain pills, serious side effects, addiction or overdose can occur even with the most well-intentioned use of the medication taken as prescribed.

A reduction in dosage might not stop chronic users from taking more pills, but if lower doses are used at the onset, the level of dependence leading to addiction might decrease.

There is nothing wrong with relieving pain, but given the opioid crisis in the U.S., something needs to be done.

Putting less of the opioid ingredient in each pill is not a perfect solution, but it’s definitely a start.

About the Author