Opioid painkillers — prescription drugs such as Vicodin, Oxycontin and codeine — have legitimate uses for acute, severe pain or tough-to-treat chronic pain. But with growing awareness of the overprescribing, overdose and addiction potential of these drugs, it’s clear they need to be taken with care. If you’re worried about your opiod regimen — or a loved one’s — experts describe early signs of trouble and discuss how to take these drugs safely.

Causes for Concern

Physical and behavioral changes provide early clues to problem opioid use, says Dr. Joseph Lee, medical director of the Hazelden Betty Ford Foundation Youth Continuum. Tolerance is when your body needs more opioids to get the same amount of pain relief. Withdrawal, when your body reacts to missing regularly scheduled doses with mood shifts, stomach problems or sweating, is another.

When you start noticing that taking these medications becomes your paramount priority each day, that’s a problem, Lee says. Scheduling your life around your next dose of pain medication, or realizing you’re becoming too preoccupied with its use, are signs you shouldn’t ignore.

“If you find that you’re running through your supply of medications faster than intended, or having to increase dosages faster than the doctor’s recommending,” those are warning sings, he says. “If the feeling you get from taking the pill is too euphoric or calming or rewarding in some way.”

Experiencing a false sense of peace and “everything’s right with the world” feeling with opioid use can signal early trouble. “If you hear a lot of people who are addicted to pain medications, in particular, they’ll tell you the first time they took it was a very magical feeling,” Lee says. For other patients, it may take longer to feel this emotional “reward.”

Before You Begin

Always question whether opioid pain medications are really warranted by your medical condition, Lee says. “Before [patients] run down that road of, ‘Am I going to misuse or not?'” he says, they should ask, “Is there clear evidence that I can take this safely?”

History of substance abuse issues — your own or within your family — is a consideration. “If you are somebody who has struggled with any substance use before, whether it’s smoking cigarettes, drinking alcohol excessively or smoking marijuana or using benzodiazepines, the chances are greater that you may have a problem,” Lee says.

If You Start

When you start a new medication, your health care provider should explain why you’re taking it, how to take it properly and potential complications and drug interactions.

“Physicians have a special responsibility to inform their patients of the risks of dependence and misuse whenever they provide a scheduled substance,” says Dr. Melinda Campopiano of the Substance Abuse Mental Health Services Administration. “That is a professional responsibility that any prescriber, not just physicians, has, whether it’s opioids or a sleeping medication or a stimulant.”

Like any medication, opioids have side effects, says Campopiano, who is the medical officer for SAMHSA’s Center for Substance Abuse Treatment. “One of them is the formation of dependence and the pattern of opioid-use disorders that can result.”

You can monitor yourself for safe opioid use in several ways. “Number one is only taking medication as prescribed,” she says. “Exactly as prescribed. If you find yourself concocting excuses to take medication a little early, or sort of justifying not following the doctor’s orders for some reason, you probably need to stop and check yourself.”

If the medications as prescribed aren’t effective — you’re not getting adequate pain relief — sit down with your doctor to discuss alternatives, she says, rather than make adjustments on your own.

Ready for a Refill?

When your initial painkiller prescription runs out, it’s a good moment to make a thoughtful assessment of how you’re doing overall, rather than automatically accepting a refill.

“Each time that you get a refill would be a good time to mentally have the practice and the habit of going, ‘Where am I with my well-being and my healing?’ and ‘What is the role this medication’s playing for me?'” Campopiano says.

Cautionary Tale

It’s a too-familiar tale: The successful family and businessman who has it all becomes addicted to painkillers after unsuccessful back surgery and almost loses everything, including his home and family. But that’s how it was for Scott Jernigan, 52, a father of two in Florida.

On an initial four-week course of opioid medications, Jernigan found he liked the painkillers almost immediately. “I learned very quickly that not only does this numb the pain, but it numbs everyday life’s stresses and strains,” he says.

He shares early painkiller problem signs to recognize. “When you don’t take it as prescribed,” he says. “Or you need to take it before [it’s due]. Say your doctor prescribes it for six hours. And you’re taking it every four hours. At that point, you need to figure out, ‘Am I really taking this for pain? Or am I really taking this because I like it?'”

Jernigan’s gradual descent into addiction and eventual acceptance into a clinical trial for an opioid-addiction treatment called Probuphine — a long-acting medication implant from Braeburn Pharmaceuticals on track for U.S approval — was detailed online in a recent BuzzFeed article.

The one thing Jernigan wishes he’d done when he realized how much he liked opioids: “Stopped taking them,” he says flatly.

Do You Know Where Your Drugs Are?

Before you bring home any drug with potential for abuse, Lee says, “You have to ask, ‘What am I doing for diversion? How am I storing this? How will I dispose of it?'”

To prevent drug diversion, which can lead to tragic consequences, Lee suggests storing medications in a locked medicine cabinet or even a safe. Don’t save or hide unused painkillers in your hall closet for some future rainy day, he adds, because you can lose track over time. Instead, he suggests, dispose of them in the trash with used coffee grounds and other refuse so they’re no longer worth taking.

Family Lookout

When patients are ambivalent or in denial about signs of opioid misuse, family members may have to step in. “You definitely want to watch for [loved ones] taking the medication too early, taking more medications than is ordered and running out of the medication before the next refill would be due,” Campopiano says.

Notice how family members respond when they take their medication, she advises: “Whether they’re demonstrating, ‘Oh, I can get up and shower’ or ‘I feel well enough to sit at the table and have dinner’ versus ‘I’m kind of giddy and maybe being more active than I should be.'”

While such mood changes are not diagnostic of addiction, she says, “That might mean someone is struggling to balance the depression and isolation symptoms that are caused by illness and injury with the effects of the medication.”

Manipulating medication — for instance, chewing on a tablet that’s supposed to be swallowed to make it act more quickly — is a red flag, she says. And “losing” pain medication can be another sign of a slippery slope.

“When you come back home and your convalescing family member is there and they can’t find their prescription, you have to ask yourself — for the safety of this person — whether there’s something going on you should be concerned about,” she says. “You don’t have to be angry; you don’t have to be confrontational.”

However, Campopiano says, potential opioid abuse is too dangerous to not address. “Because it’s about this person’s life and well-being. So we owe it to one another and ourselves to ask the hard questions about our behaviors,” she says.

Some people with certain conditions, such as pain syndromes like fibromyalgia or extensive spinal arthritis, rely on opioid medications to function from day to day (although controversy about chronic opioid use persists).

“It would be really tragic for people who have chronic pain or severe acute pain to not be able to get these medications when they need them,” Campopiano says. “We need to help one another be vigilant and be honest with one another about the use of these medications. And the family is a good place for that to start.”

More from U.S. News

8 Questions to Ask Your Pharmacist

11 Ways to Cope With Back Pain

11 Simple, Proven Ways to Optimize Your Mental Health

Could You Be at Risk for Painkiller Addiction? originally appeared on usnews.com