Category: Medication

All medicines need to be used and looked after safely, however there are additional measures that should be taken with controlled medicines (controlled drugs or CD’s). This is because they may cause serious problems like dependence (‘addiction’) and harm if they are not used properly. Sometimes people use these medicines illegally for reasons that are not medical (drug misuse), and so extra safety measures are needed to make sure they are prescribed, supplied, used and stored safely and legally. Controlled medicines include some strong painkillers, such as morphine, and some tranquillisers and stimulants.

➢ Patient information leaflets: All licensed medicines come with a patient information leaflet. This gives information about what the medicine is for and how the medicine should be taken. You should follow the instructions your doctor has given you (as on the pharmacy label). If you have any queries, please speak to your doctor or pharmacist
➢ Use the medicine as directed on the label: Make sure you understand exactly how and when to take your medicines. Swallow tablets or capsules with a glass of water, unless otherwise stated. If possible stand or sit upright.
➢ Controlled medicines can affect the way that you react to situations and may impair your ability to drive or operate machinery. It is against the law to drive if your ability is impaired. Do not drive when taking controlled drugs until you know how they will affect you and following any changes in dose. Check the patient information leaflet with your medicine for more information.
➢ Store all medicines safely: Make sure they cannot be seen or reached by children or vulnerable adults. This may require the use of a lockable drawer or cabinet.
➢ Never share your medicines: Your medicines have been prescribed for you to take – nobody else.
➢ Side effects: Some medications may have unwanted side effects. Many are minor, harmless or short-lived. Patient information leaflets will list reported side effects. This does not mean that you will experience these side effects. If you experience side effects that are particularly troublesome or persistent contact your doctor or pharmacist.
➢ Prescriptions for controlled medicines will only be supplied for a maximum of 28 days at a time. As they cannot be supplied by the pharmacy without a prescription, please ensure that you request them from the surgery before they run out (maximum of 5 working days).
➢ Disposal of medicines: medicines no longer required must be disposed of safely. This can be ensured by returning unwanted medicines to your Community Pharmacy.

Opioids are a group of medicines that have similar effects to morphine. Medicines in this group include buprenorphine, codeine, dihydrocodeine, fentanyl, oxycodone, tapentadol and tramadol. They are particularly useful for pain after surgery or trauma, and may help conditions such as arthritis, nerve pain and back pain, for up to three months. However, opioid medicines are much less effective over lengthy
periods. They can sometimes lead to an increase in pain and many other harmful side effects.

Gabapentanoids Such as gabapentin and pregabalin are medicines that can treat nerve pain, diabetic neuropathy, (nerve pain in the feet), generalised anxiety and restless leg syndrome.

Benefits of opioids and gabapentanoids
Both opioids and gabapentanoids can only help to relieve pain, if successful then pain can be reduced by around 20-30%, it is unlikely that they will take the pain away completely. It is hoped that if you experience some pain relief you will be able to be more active and improve your quality of life, increasing your daily activity with gentle stretching, short walks, or activities you enjoy.

However, opioids and gabapentanoids have a limited effect and for some will not give any substantial benefit. If they are not helpful after a few weeks, further increases to the dose may not be appropriate.

Side effects and harms
Common side effects of opioid medicines include constipation, fatigue, drowsiness, dizziness, nausea, poor concentration, depression, increased anxiety, sweating, itching, changes to the normal breathing pattern, hormone changes that can lead to a low sex drive, reduced bone density and infertility. Life expectancy can also be lower for a person taking high doses of opioids for a long time. Gabapentanoids can often cause dizziness, fatigue, confusion, headache, drowsiness, tremors, sexual dysfunction, weight gain and abnormal appetite. Tolerance to these medications will develop over time, meaning they are less effective, and you may become addicted or dependant on them. Taking combinations
of these medicines in high doses is likely to increase the side effects you could experience and can cause severe drowsiness and breathing problems.

Taking opioids and gabapentinoids for prolonged periods of time can also increase your pain and reduce your ability to function and carry out your daily activities and can become increasingly harmful to your general health. Some people may feel they do not have any noticeable side effects; however, they will still be at risk of the harmful effects the liver, kidneys, endocrine system (hormones), bones and joints and respiratory system.

Alternative options
Managing long-term pain is best if you learn other ways to manage it, such as stretching and exercise, relaxation and pacing activity e.g., breaking activity down to make it more manageable, meditation and mindfulness are also recommended. There are other alternative medicines to opioids and gabapentanoids that may help a small number of people. This should be discussed with your doctor or nurse.

Next steps
• Do you still have pain despite using opioid medicines regularly?
• Do your medicines cause side-effects that affect your daily activities e.g., drowsiness that stops you driving
• Have you noticed a change in your sex drive or sexual function?
• Do you take your medicine because it helps you to relax or make you sleepy? If you answer ‘yes’ to any of these questions, it is likely that the
opioid/gabapentanoid medicines are not suitable for you. If you would like to discuss your medicines and the alternatives options suitable for
you, you can contact the pain clinic or your GP for further support and advice

Useful resources
Understanding and living with long term pain.
www.Livewellwithpain.co.uk
www.britishpainsociety.org
www.knowpain.co.uk
www.retrainpain.org
www.picsnhs.org.uk/pain-pathway
ACT, mindfulness, and others
www.wildmind.org (Site has a programme of online mindfulness instructions)
www.workingwithact.com
www.actionforhappiness.org
PICS (Primary Integrated Community Services) 0300 830 000-option 1
Insight (free talking therapies) 0300 555 5582

Further Information and reading
Overcoming Chronic pain: A self help guide using cognitive behavioural techniques, Frances Cole et al.

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