Opioid painkillers are only available on a prescription and must be prescribed by a doctor, or nurse prescriber if it's in their scope of practice. They're used to help relieve pain and improve your quality of life.
In Aotearoa New Zealand opioids are generally available in 2 forms:
- short-acting (liquid or tablets) to relieve pain quickly, or
- slow-release (tablets or capsules) that you take 1 or 2 times a day to give stable pain relief throughout the day.
When you first start taking opioids you may be prescribed the short-acting liquid or tablets to find out how much of the opioid medicine you need to manage your pain.
After this, it’s common to be prescribed both forms of opioids. The slow-release tablets or capsules are taken regularly every day.
The immediate-release tablets or liquid is a lower dose that can be used, if and when required, for any sudden increase in pain – this is also commonly called ‘break-through’ pain. If you have to use your breakthrough pain medicine more than twice a week, talk to your healthcare provider about reviewing your pain management.
When choosing an opioid to manage your pain, your healthcare provider may discuss the following things with you.
- Choice of opioid: Morphine is the most commonly used opioid for severe pain. Other opioids include oxycodone, fentanyl and methadone.
- 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're having trouble swallowing tablets or capsules, you may be prescribed a liquid or a patch to put on your skin. Remember, not all tablets can be crushed or cut – ask your prescriber 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 shouldn't cause breathing difficulties (also called respiratory depression).
- Side effects: All opioids can cause side effects such as constipation, nausea (feeling sick), dizziness and sleepiness. Constipation is common with all opioids so you’ll also be prescribed a laxative to take regularly. You may also be prescribed medicine for nausea to take just when you need it. Opioids can affect your driving. Don’t drive or if you have to, check if you have any symptoms before getting into your vehicle. Read more about driving and medicines.
- 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 isn't working as well as it used to, tell your doctor so they can review your dose, prescribe a different medicine, 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 healthcare provider and develop a plan for how to best manage your pain. Having pain doesn’t always mean that your pain plan isn't working. It may mean that your medicines need to be reviewed. For examples of pain plans see my pain management plan(external link) from NPS Medicinewise or developing a pain control plan(external link) from the American Cancer Society.
