What are opioids?
Opioids are strong painkillers. They work by changing the way your brain and spinal cord feel pain. Doctors sometimes give them after an operation, after a big injury, or for cancer pain. Sometimes they are used for long-term pain, but they do not help everyone and are no longer recommended by the NHS.
Examples include codeine, dihydrocodeine, Tramadol, morphine, Zormorph, Longtec, Shortec, Buprenorphine and Fentanyl.
What your doctor needs to know before prescribing them:
Tell your healthcare team if you:
• are allergic to any medicine,
• take other medicines or herbal remedies,
• are pregnant, planning pregnancy, or breastfeeding,
• have kidney problems,
• have ever had problems with alcohol, drugs, or addiction.
How do you take them?
Opioids come in different forms: tablets, capsules, liquids, injections, and skin patches.
When should I take them?
If you have pain all the time, your doctor may give you slow-release tablets or a patch. These give medicine all day to keep the pain level steady. Fast-acting opioids are not as useful for pain that never goes away.
What if I miss a dose?
Take it when you remember. If it’s nearly time for your next one, skip the missed dose. Never take two doses together.
How much should I take?
The best dose is the smallest amount that makes your pain better. It is rare for opioids to take all the pain away. Always take the amount your doctor has prescribed. If it is not working, or the side effects are a problem, speak to your doctor.
How quickly do they work?
Fast-acting tablets can work in about an hour and last a few hours. Slow-release tablets and patches take longer – sometimes a couple of days – before you feel much effect.
Side effects
When you first start taking opioids, you might feel:
• dizzy,
• sleepy,
• sick or be sick,
• muddled or confused.
These problems usually get better after a few days. Constipation (difficulty pooing) is very common and does not usually go away. You may need another medicine, called a laxative, to help. Other possible problems are itching, weight gain, and low sex drive. Some people may have trouble breathing at night, especially if overweight or if they snore.
Can I drive?
In the UK you can drive if your doctor prescribed the opioids and you take them as told. But you must not drive if you feel sleepy, unsafe, or muddled. Opioids can slow your reactions. Never drive in the first few days after starting them or after a change in dose. Drinking alcohol makes it more unsafe.
Alcohol and opioids
Both make you sleepy and slow your thinking. Avoid alcohol when you first start or when your dose changes. When stable, small amounts of alcohol may be okay – but never mix alcohol and opioids if you are going to drive or use machines.
Long-term use
Research into effective pain medication for chronic pain has moved on in the last few years. It is now known that opioids (such as codeine, Tramadol, morphine) are not very effective for treating this type of pain, but they are still commonly prescribed.
Taking opioids for months or years can cause problems. These may include:
• difficulty having children,
• low sex drive,
• irregular periods,
• problems getting or keeping an erection in men,
• lower ability to fight infections,
• sometimes more pain, not less.
Because of these risks, your doctor will check your treatment regularly. Some people are able to slowly lower their dose and find their pain does not get worse – and sometimes life feels better with fewer side effects.
This video explains more about this and why opioids may not be the best thing for you.
Tolerance, dependence, and addiction
Over time, opioids may stop working as well. Your body can also get used to them, so stopping suddenly can make you feel unwell (withdrawal). Symptoms can include sweating, runny nose, tummy pain, diarrhoea, and aching muscles.
Addiction is rare when opioids are used for pain. Addiction means craving the medicine, taking more than you should, or continuing even when it harms you. The risk is higher if you have had problems with alcohol or drugs before, or if you have severe anxiety or depression.
Stopping opioids
Do not stop suddenly. Always speak to your doctor or nurse, who will help you reduce them slowly and safely.