Opioid medicines overview

Opioids should not be the first medicine you try for pain relief, if you have chronic (ongoing) non-cancer pain. They're not very effective for chronic pain and there are risks of side effects and addiction. It's important to try other treatment options such as lifestyle changes, self-management skills and other medicines. Read more about chronic pain.

The following video provides information to people who may be considering taking opioids for chronic (ongoing) non-cancer pain. This video is not for people taking opioids for cancer pain or palliative care. The video may take a few moments to load.

(NPS MedicineWise, Australia, 2020)

Opioids are strong medication with good pain relief but may cause harm from side effects and dependence. Here are a few tips on how to use opioids safely.

Dosing

• Follow the instructions on the pharmacy label for how much to take and how often. 
• Don't increase your dose or take doses more often than prescribed without talking to your doctor first.
• If you’re drowsy or sleepy, don’t take your next dose until you’re wide awake and ask your healthcare provider for advice.
• Sometimes you may feel pain before your next dose is due. Talk to your doctor about this so your dose can be changed, or another pain relief option can be considered.
• If you’re also prescribed paracetamol or anti-inflammatories, you can use them with your opioid medicine. If you’re unsure, ask your healthcare provider.
• Opioids can become less effective with time. This is called tolerance. It means that your body has got used to the pain-relieving effect of the medicine, so you will need more to get the same effect. This is why your doctor needs to know exactly what dose you're taking. 

Driving

• Opioids can cause drowsiness and confusion and can affect your ability to concentrate.
• You're more likely to feel drowsy at the start of treatment and when you have a dose increase.
• It's best not to drive if you have just started taking an opioid or if the dose has been recently increased. 
• Once you are settled on the dose, and if you don't have any side effects that might affect your driving, you may be able to return to driving.

Alcohol

• Drinking alcohol as well as taking an opioid may increase drowsiness, especially at the start of treatment or when the dose is being increased.
• If you're drowsy, don't drive or operate machinery.
• It's better to drink less alcohol or avoid it completely if you're taking an opioid.

Stopping opioids

• If you've been taking opioids for a while, don't stop taking them suddenly without talking to your doctor. You may have withdrawal symptoms if you stop them or lower the dose too quickly. 
• Withdrawal symptoms include tiredness, sweating, diarrhoea, restlessness and irritability.
• To avoid this, your doctor will reduce your dose gradually. 

Note: In this video, Dr Mike Evans mentions some opioid medicines that are not available in Aotearoa New Zealand, such as Percocet, Vicodin, Dilaudid, and many statistics that are relevant to the United States. However, much of the video is still relevant to New Zealanders. The video may take a few moments to load. 

(Dr Mike Evans, US, 2013) 

Eat plenty of fibre and drink more water

It might be hard or painful to have a bowel motion/poo (constipation). If this happens, ask your healthcare provider for a laxative, to soften your poo. Eating foods with fibre, drinking plenty of water and keeping active can help. Let your doctor know if you are feeling unwell or if you have tummy pain.

Try other ways to manage your pain

Opioids reduce strong pain but won’t take all of your pain away. Try relaxation techniques, gentle exercises and stretches. You may also be given other types of pain relief such as paracetamol and anti-inflammatories.

Tell all your healthcare providers you’re taking opioids

Opioids can affect some medicines. Ask your doctor or pharmacist if it’s safe to take any other medicines – especially those you take for pain, anxiety, sleep or depression.

If you’re breastfeeding

Don’t take opioids if you’re breastfeeding, unless advised by a specialist. Because opioids cause drowsiness, sleeping with your baby is dangerous. Put your baby to sleep in their own bed.

Be aware of the risk of dependence

If you have become dependent on your opioid medicine, your body starts to rely on them and you'll experience withdrawal symptoms if your dose is reduced or stopped. Dependence can occur within 1 month of starting to take an opioid. Read more about opioid withdrawal symptoms.

Although they may not realise it, the main reason some people continue to take opioids long-term is to avoid withdrawal symptoms. They mistakenly think the opioid is working to reduce pain, when in fact it’s only reducing withdrawal symptoms – which can include pain. The best way to prevent dependence is to use opioids for the shortest amount of time, and at the lowest possible dose. 

As with all medicines, opioids can cause side effects, although not everyone gets them. Common side effects include the following: