Pain Service - Opioids

Opioids are a group of medicines which include morphine and oxycodone.

They are used in the treatment of severe pain when weaker analgesics (painkillers) have not been effective. There are lots of types of opioids and they are available in many different forms to assist in the ease of administration.

These include tablets, capsules, syrups, patches to stick on the skin and injections. Opioids can help many people to control their pain, but not everyone.

Not all types of pain are sensitive to this pain relief and side effects can make it difficult to use regularly.

Are there different types of opioids?

There are different types of drugs in this group. Some examples are below:

• Codeine
• Dihydrocodeine
• Tramadol
• Tapentadol
• Morphine
• Oxycodone
• Buprenorphine
• Fentanyl
• Methadone

Their strength varies depending on the drug and the dose.

What is the normal dose?

You will usually start on a low dose of opioid and then, with guidance from your doctor or nurse, gradually increase until you find the dose that works best for you.

The dose of the medication and the way it is taken will depend on which opioid you have been prescribed. They must be taken exactly as your doctor or nurse has advised.

What are the side effects?

The most common side effects are feeling sick (nausea), drowsy, dizzy and confused when you first start to take the medication.

For most people these side effects wear off after a few days as you get used to the medication. Some people have constipation, sleepiness and feel itchy. You may need medicine from your general practitioner (GP) to treat any side effects.

If you feel drowsy do not drive or operate tools or machinery and do not drink alcohol. Difficulty in breathing is most common if you are overweight and if you snore heavily. If you have a condition called obstructive sleep apnoea it may not be safe for you to take opioids.

What are the long-term effects of taking opioids?

If you take opioid drugs for many months or years it can affect your body in other ways. These problems are more common if you take high doses of drugs for long periods. These problems include:

• Reduced fertility
• Low sex drive
• Irregular periods
• Erectile dysfunction in men (the inability to keep an erection)
• Reduced ability to fight infection
• Increased levels of pain

There is a full list of known side effects described in the leaflet that comes with your medication when it is dispensed by your pharmacy.

You will need to get further supplies of your pain relief medicine from your GP and your medication must be stored carefully and out of sight and reach of children.

It is important that you know you are taking the opioid for pain. When it is used to control pain it is rare for patients to become addicted.

Will my body get used to opioid medicines?

Opioids can become less effective with time (this is called tolerance).

This means that your body has got used to the pain-relieving effect of the medicine. You can also become dependent on opioid medicines (dependence). This means that if you stop taking the drug suddenly, or lower the dose too quickly, you can get symptoms of withdrawal.

If you run out of medicine, you can experience the same symptoms which include:

• Tiredness
• Sweating
• A runny nose
• Stomach cramps
• Diarrhoea
• Aching muscles

What about addiction to opioids?

It is very rare for people in pain to become addicted to opioids. People who are addicted to opioids can:

• Feel out of control about how much medicine they take or how often they take it
• Crave the drug
• Continue to take the drug even when it has a negative effect on their physical or mental health

We do not know exactly how many people get addicted when they are taking opioids for pain relief but it is very uncommon.

It is more common if you have been addicted to opioids (including heroin) or to other drugs (or alcohol) before. Addiction may be more common in people with severe depression or anxiety.

This does not mean that if you have had an addiction problem before or you are very depressed and anxious you will become addicted. It only means that you are more likely to become addicted than someone who has not had these problems.

Most people do not become addicted. So, if you have had a problem with drug or alcohol addiction in the past this doesn’t mean that you cannot take opioid medicines for your pain.

However, your health-care team will need to know about your past or current drug-taking to prescribe opioids safely and to help you watch out for warning signs.

What if I am pregnant and need opioids?

If you take opioids during pregnancy your baby might have breathing difficulties at birth or symptoms of opioid withdrawal.

The symptoms can vary from baby to baby. The baby will need specialist help, though usually only for a short time. If you are taking opioids you need to talk to your doctor before planning pregnancy.

In some situations you may need to stop taking the opioids but sometimes they can be continued under medical supervision. If you become pregnant while you are taking opioids you should talk to your midwife or doctor and you should not suddenly stop taking the opioids.

Will I need opioids forever?

Some people take opioids for many years.

If opioids give you pain relief you will feel that you rely on them. This is normal. If you want to try reducing your dose you should discuss this with your doctor and bring the dose down slowly.

Many people find that after a few months they can reduce their dose without their pain increasing.

Will it affect my other medicines?

Before you take or buy any new medicines, including herbal remedies, tell your doctor or pharmacist that you are taking strong opioids and ask their advice.

Can I drive if I am on opioids?

The law in the UK allows you to drive if you are taking opioid medicines. If you are not drowsy after you have been taking strong opioids for the first few days you can start driving. You should inform your car insurance company about taking opioids. Please carry your prescription with you.

You should not drive if you have changed your dose or if you feel unsafe.

You are responsible for making sure you are fit to drive. The only organisation that can advise you about your legal right to hold a driving licence is the Driving and Vehicle Licensing Authority (DVLA).

What about work and activity?

Once you are taking a regular and steady dose of opioid you should be able to live a normal life. If you do not feel safe at work or at home you should let your employer and your family know.

You need to speak to your healthcare team if you are having problems with normal activity.

Stopping the medication

Depending on how long you have been taking opioids the body can possibly become physically ‘dependent’ on the opioid.

This means it must not be stopped suddenly as symptoms of withdrawal such as nausea, sweats, shakes and cramps may occur.

If you want to stop or reduce your opioid this should be done slowly over time. It is important that you tell your GP that you want to stop or reduce and follow their advice. You can also discuss any pain relief medication problems with them.

Any unused medication should be returned to your pharmacist for safe disposal.