Opioids in palliative care

Opioid painkillers are available on prescription only and must be prescribed by a doctor. The use of opioids in palliative care does not reduce time to death. Opioids are used to help relieve pain and improve your quality of life When choosing an opioid to manage your pain, your doctor may discuss the following things with you.

• Choice of opioid: Morphine is the most commonly used opioid. Other opioids include oxycodone, fentanyl and methadone. 
• Length of time before they start working: Opioids are generally available as either short acting to relieve pain quickly, or slow release that you take once or twice a day to give stable pain relief throughout the day.
• Timing of your doses: It's important to take your opioid pain relievers at the times prescribed (or as close as possible to those times) to get the most benefit from them. For example, delaying an opioid medicine that takes time to start working may result in you experiencing pain that could have been avoided.
• Swallowing difficulties: If you are having trouble swallowing tablets or capsules, your doctor may prescribe a liquid or a patch. Remember, not all tablets can be crushed or split – ask your doctor or pharmacist to check. Read more about difficulty swallowing medicines.
• Syringe drivers: If you can't take medicines such as tablets, capsules or liquids by mouth, a syringe driver may be used. A syringe driver is a small, portable, battery-operated pump used to inject medicines under the skin. Read more about syringe drivers.
• Breathing difficulties: Appropriate doses of opioids should not cause breathing difficulties (also called respiratory depression).
• Addiction: Opioid addiction is uncommon in people with pain caused by a terminal illness.
• Tolerance: Opioids do become less effective over time because your body becomes used to the medicine. This is called ‘tolerance’. If your medicine is not working as well as it used to, tell your doctor so they can review your dose, or prescribe a different medicine, or choose a different form, or prescribe a combination of medicines.
• Pain control plan: Your pain is unique to you. It's important to discuss your pain management options with your doctor and develop a plan on how to best manage your pain. Having pain doesn’t always mean that your pain plan is not working. It may mean that your medicines need to be reviewed. For examples of pain plans see my pain management plan(external link) NPS Medicinewise or developing a pain control plan(external link) American Cancer Society.