Pain Service - OPIOID Painkillers following Discharge from Hospital

You have been prescribed strong painkillers for your pain, known as ‘opioids’. They are called; morphine, oxycodone, fentanyl, tramadol and buprenorphine.

These strong painkillers help to reduce pain after surgery or injury, allowing you to be more active and get better more quickly.

They can cause side effects including:

• Drowsiness/sleepiness
• Constipation (difficulty opening bowels)
• Itching
• Nausea/feeling sick

For all side effects, see patient information leaflet given with medications.

Will I have to take strong painkillers for a long time?

The amount of strong pain killers you are taking should be checked by your healthcare team. The aim is to reduce and stop the strong painkillers when you do not need them anymore.

There might be times when your strong painkillers are carried on, such as if you have ongoing pain that was present before surgery and not treated by your operation.

For most patients the aim is to reduce and stop any opioid medicines as you improve after your operation.

Do strong painkillers work?

The aim of strong painkillers is to reduce pain enough to help you get better more quickly. This is by making it easier to practice deep breathing, coughing and walking. It may not be possible to stop all of your pain but it should be manageable.

Often other painkillers are also needed such as; paracetamol or sometimes medicines used for nerve pain such as gabapentin, pregabalin or amitriptyline.

Will I become addicted?

Addiction is unlikely if strong painkillers are taken in the correct way and reduced slowly and stopped when your pain has improved.

When should I seek advice from a healthcare professional?

You should contact your doctor/nurse if you experience any of the following:

• Become more drowsy or sleepy than usual
• Vomiting or feeling sick for more than 24 hours
• If you feel confused
• If you experience hallucinations
• If you develop breathing difficulties or cannot stay awake while taking strong painkillers, you or your relative should seek urgent medical advice or dial 999 for an ambulance

Who should I contact out of hours if I have concerns?

• If it is soon after discharge you can phone the ward for advice as detailed in your discharge letter
• First point of call should be your GP Practice
• Out of hours you may be directed to an out of hours service
• Call: 111
• WEBSITE: 111.NHS.UK
• Visit an urgent care centre such as a Walk-in-Centre

Discharge advice on dose reduction

After discharge from hospital, strong painkillers will not routinely be supplied by your GP.

It is unlikely you will get withdrawal effects from your painkillers supplied after your operation. As pain eases you will need to take doses less often and possibly a smaller amount.

This gradual reduction will prevent withdrawal effects.

If your pain is slow to settle and a further supply is needed, an appointment with your GP will be needed.

• Short acting strong painkillers should not be taken more often than 4-6 hourly
• Consider reducing the doses as the pain improves
• To prevent withdrawal symptoms, you need to slowly reduce the strong painkillers as advised

Withdrawal symptoms can happen if a strong painkiller is stopped/dose reduced quickly.

Symptoms:

• Sweating
• Yawning
• Abdominal/stomach cramps
• Restlessness/feeling agitated
• Anxiety

If experiencing these symptoms seek advice from your GP/Healthcare team who prescribed your strong painkillers

Pregnancy and breast feeding

Strong painkillers are very rarely prescribed for pregnant or breastfeeding women. These should only be taken as directed by your GP/Healthcare team.

Driving

It is illegal to drive with any strong painkillers in your body if you feel that they reduce your ability to drive and concentrate.

You can drive after taking these drugs if:

• You have been prescribed them and followed advice on how to take them by a healthcare professional
• They are not causing you to be unfit to drive even if you are above the specified limits

Talk to your doctor about whether you should drive if you have been prescribed strong painkillers.

Long acting opioids/strong painkillers

If you are taking long acting strong painkillers, these need to be reviewed by your doctor and if possible slowly reduced as your recovery continues.

Examples of long acting opioids:

• Modified-release 12 hourly preparations, eg. Morphine Sulphate Tablet Continus. Oxycodone Prolonged Release
• Modified-release 24 hourly preparations, eg. MXL capsules
• Transdermal patches, changed every 3, 4 or 7 days, eg. Buprenorphine or Fentanyl

Storage

• Store in a locked container
• Keep in their original package
• Keep out of children’s reach
• Do not share your medication
• Safely dispose of unused medication by taking them to your local community pharmacy

Destruction

All medications can be returned to a pharmacy for safe disposal.

Contact details for further advice:

Please speak to your GP if further advice is needed.

You can find additional information on opioids/strong painkillers on the following websites:
https://fpm.ac.uk/opioidsaware
https://www.gov.uk/drugdriving-law