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Prescribing drugs of dependence in general practice

Part C2 - The role of opioids in pain management

Appendix A

Last revised: 02 Jun 2020

Table A1

Table A1

Pharmaceutical Benefits Scheme listing of opioid analgesics


Using opioid medicines to treat your pain

You and your doctor have decided that opioid pain medicine might help reduce your pain and improve your functioning in daily life.

It is important to understand that opioids are not likely to make your pain go away completely, and that this treatment involves potential risks and benefits. It is also important that you follow the guidelines in this handout and let your doctor know what you expect from your treatment. Your doctor may ask you to sign an ‘Opioid patient care agreement’.

What are the goals and possible benefits of opioid treatment?

The goals of treatment are to reduce your pain and improve how you function on a day-to-day basis. The benefits of opioid medicines vary from person to person. Opioids typically reduce chronic pain by about 30%, and some people find that they can function better day to day, but research has shown this is not achieved in all patients.

Experts agree that opioids may make pain worse, especially at high doses. ‘Flare-ups’ are common and should not usually be treated by increasing the dose or taking extra medicine.

Your doctor will monitor how you are doing by asking you to rate your pain level and your daily functioning. They may want to know how far you can walk, how long you can sit, whether you are able to work or do housework, and what kinds of activities you do alone or with family and friends.

What are the common side effects and risks of opioids?

Opioids cause common side effects that can be unpleasant. They can also increase risks of serious health issues. Because opioids have risks that can be serious, your doctor may ask you for a urine or blood sample to help protect your safety.

Side effects vary from person to person. You and your doctor will work together to monitor how opioids affect you. Your doctor may need to adjust your dose until you find the right balance between pain reduction, improved function and side effects.

It is normal to develop physical dependence on opioids. Physical dependence means your body has adapted to the medicine and you will experience tolerance and withdrawal. Tolerance means you need to take more of the medicine to get the same effect. Withdrawal means you will have symptoms when you stop using the medicine.

Withdrawal symptoms are usually the opposite of the effects of the medicine. For example, if the medicine causes constipation, the withdrawal symptom would be diarrhoea. If the medicine reduces pain, the withdrawal symptom would be increased pain. Withdrawal from opioids is temporary and usually not dangerous.

If you do get pregnant while taking opioids, let your doctor know right away. Babies born to mothers taking opioids will be dependent on opioids at birth. You should not take opioids if you are trying to get pregnant.

People who have had problems with mental health, drugs or alcohol are more likely to have problems with opioids. You must tell your doctor about any mental illness, substance abuse or addiction of any type you have experienced in the past. You must also tell your doctor if anyone in your family has had these problems. Research shows these problems sometimes run in families.

Experts agree that people with active substance abuse or addiction problems should not use opioids for chronic non-cancer pain (CNCP). If you have problems with substance abuse or addiction, it is important to let your doctor know so you can get the help you need. Tell your doctor right away if you feel you are becoming addicted to opioids.

Common side effects

Other side effects

Withdrawal symptoms

Constipation
Opioid medicines cause constipation. You may need to be treated for this while you are taking opioids.

Sedation
Many opioid medications can make you feel drowsy, slow your reaction time, and cause loss of coordination. They can also make it hard to concentrate and think clearly.

Do not drive or use dangerous equipment until you are sure that opioids do not affect your reaction time or thinking ability. It may take a week or longer before you know if you can drive safely while taking opioids. If you are in a traffic accident while driving on opioids, you may be considered to be driving under the influence.

Rash and/or itching
Dry eyes
Blurred vision
Nausea and vomiting
Inability to urinate
Low blood pressure
Slow heartbeat
Depressed mood
Slowed breathing
Problems with balance
Decreased sex drive (decreased testosterone)
Decreased immune function
Swelling in hands and feet
Jerking of arms and legs
Increased sensitivity to pain
Disruption of normal sleep
Dental problems
Apathy
Falls resulting in fractures

Sweating
Nausea
Abdominal pain/cramping
Diarrhoea
Trouble sleeping
Muscle aches
Fast heartbeat Anxiety
Runny nose
Goose bumps

Risk of serious bodily harm or death

Opioid pain medicines can cause serious bodily harm or death. Higher doses appear to cause more side effects, leading to sedation, injuries and serious fractures due to falls. Higher doses increase the risk of overdose. An overdose of opioids, whether by accident or on purpose, can cause serious bodily harm or death. Research continues to show more and more problems with long-term opioid use, especially at high doses.

Using more opioids than your doctor prescribes can cause you to become dangerously sedated, stop breathing or overdose. Combining opioids with certain other medicines or with alcohol or drugs can have the same effect.

Are there alternatives to opioid treatment for chronic non-cancer pain?

Your doctor may prescribe other treatments to help your pain and to help you do daily activities better. These may include exercise, psychological counselling and medicines that are not opioids. Please be sure to discuss these options with your doctor.

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