Although millions of people benefit from opioids, the pain relief these drugs provide often comes with some undesirable side effects, such as itching or pruritus. In some cases, some patients experience such intense itching with opioids and opiates that their doctors have to either cut back their dose or switch their medication altogether. Both opioids and opiates are also known for being highly addictive, so itching is also a common side effect of opioid misuse. But why do opiates make you itch? Let’s get to the bottom of it.
Why Do Pain Pills Make You Itch?
Up until recently, many experts assumed that itching from opiates and opioids was unavoidable because it was simply a side effect of the drug’s impact on the nervous system. There are four main types of receptors in the brain that respond to opiates, each of which contains structural variants called isoforms.
Most opioid medications are non-specific, meaning that they’ll bind to all isoforms. These structures and the receptors they’re in can be found in the brain, spinal cord, gut, and other areas of the body.
When a person ingests opiates, the drug binds to these receptors, blocking pain signaling from the body to produce pain relief. In addition to blocked pain signaling, opioids also impact neural communication and activity in the central nervous system, particularly by increasing levels of dopamine.
Research found that opiates make you itch because of a process known as degranulation. The receptor protein MRGRPX2 exists on the surface of mast cells and initiates a process called degranulation, which causes the release of histamine and other inflammatory responses, leading to allergic reactions like itching.
The MRGRPX2 receptor is about one of the 120 receptors in the human body referred to as orphan receptors because their purpose and function are unknown. This new research on the MRGRPX2 receptor could be useful in the development of other opioids that do not produce itching or those that produce less severe itching.1
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Opioid Rash
All opioids, especially naturally occurring and semisynthetic opioids, cause allergic reactions. If you recall our mention of histamine earlier, histamine goes hand in hand with opioids and itching.
Histamine is a naturally occurring chemical that causes many of the symptoms associated with allergic reactions, such as sneezing, coughing, runny nose, and, yes, itching. When a person is allergic to something, such as food or dust, the immune system attempts to protect the body by prompting cells to release histamine into the bloodstream.
As a result, histamine will act on the eyes, nose, throat, gastrointestinal tract, lungs, and skin. This is why anti-allergy medications are commonly known as antihistamines because they work to alleviate these reactions.
Codeine, morphine, and meperidine are the opioids that cause the most allergic reactions, such as skin itching. Although these symptoms can seem like a true allergic reaction (and in some cases are), they’re usually symptoms of pseudoallergies or artificial allergies caused by histamine release from mast cells, which we mentioned earlier.
Signs of a true opioid allergy usually include hives, severe hypotension, bronchospasm, angioedema, and skin rashes like maculopapular rash, erythema multiforme, and pustular rash. If you experience an opiate when taking these medications, speak to your doctor immediately, as this could be a sign of a potentially life-threatening allergic reaction.
If you do experience an opioid skin rash, your doctor may either switch your form of chronic pain treatment altogether or switch the type of opioid medication you’re taking.
When or why opioids cause itching may also have to do with other medications or food that’s ingested. It’s important to determine whether you may have an allergy to a specific kind of food or prescription drug to determine whether the opioid medication is truly causing an allergic reaction.
How to Stop Itching From Opiates
Opiate-induced itching can be uncomfortable, but there are strategies to manage it. It’s essential to address the root cause while minimizing additional complications. Here are some ways you can stop opioid itching:
- Consult your healthcare provider: If you’re experiencing severe or persistent itching while taking opiates, it’s crucial to consult your healthcare provider. They can help determine the cause and adjust your medication or treatment plan accordingly.
- Hydration: Staying hydrated can help alleviate itching, as opiates can dehydrate the body, which may contribute to skin irritation.
- Antihistamines: Your doctor may prescribe antihistamines, such as diphenhydramine (Benadryl), to counteract the histamine release responsible for itching.
- Topical creams: Over-the-counter hydrocortisone cream can help relieve itching by reducing inflammation in the affected area. Apply it sparingly and according to the product’s instructions.
- Cool compresses: Applying a cool, damp cloth or ice pack to the itchy area can provide temporary relief. Avoid applying ice directly to the skin.
- Avoid scratching: Scratching can worsen itching and lead to skin damage or infection. Try to resist the urge to scratch the affected area.
- Mindful clothing: Wear loose-fitting, breathable clothing to reduce friction and irritation on the skin. Avoid materials that may exacerbate itching, such as wool.
- Keep skin moisturized: Dry skin can worsen itching. Apply a fragrance-free, hypoallergenic moisturizer to keep your skin hydrated.
- Reduce opiate dosage: Your healthcare provider may consider reducing your opiate dosage or exploring alternative pain management options to minimize itching.
- Consider alternative medications: Depending on your medical condition, your doctor may explore alternative medications with less-pronounced itching as a side effect.
It’s essential to remember that managing itching from opiates should be done in consultation with a healthcare professional. They can assess your specific situation and recommend the most suitable approach. Furthermore, abrupt cessation of opiates can lead to withdrawal symptoms, so any changes in your medication should be closely monitored by a medical expert to ensure your safety and well-being.
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Additional Risks to Keep in Mind
Not only do opioids make you itch, but they’re also highly addictive. While opioid-induced itching can be an annoying symptom, it’s considerably less severe in comparison to physical dependence and addiction.
In fact, constant itching or skin rash can actually indicate that someone may be using opioid medications that they shouldn’t. Long-term use of opiates, even as directed, can also lead to physical dependence.
If you or a loved one finds themselves needing a higher dose to experience pain relief, speak to your doctor about other treatment options. Oftentimes, patients who realize that one dose isn’t as effective anymore may start taking more of the drug without consulting their doctors first.
This increases your risk of addiction as well as overdose. If you’ve developed an addiction to an opioid medication or know someone who has, our treatment center in Palm Beach offers opioid addiction treatment, among various other options that can help.
From medically monitored detox to manage withdrawal symptoms to one-on-one and group therapy sessions with our counselors, patients at our Banyan Lake Worth rehab are provided with 24-hour care and support at every step of the recovery process. Don’t wait to get yourself or your loved one help.
