Reducing and Stopping Opioid Medicines

Patient Leaflets Team

  • Reference Number: HEY1217/2021
  • Departments: Pain Medicine

Introduction

This leaflet has been produced to give you help and support in how to reduce and stop taking your opioid medicines.  Please keep it in a safe place.

Patients, family, friends and carers can play an important role in the safe use of these medications and in reducing the risk of harm.  Please share this information with them.

What are opioid medicines?

Opioids are a type of medicine that help to relieve pain.  They are very effective over short periods of time to relieve moderate to severe pain.  Opioids provide pain relief by acting on areas of the brain and spinal cord to block the transmission of pain signals.  They are considered to be the strongest pain relieving medication available and are used to treat pain after surgery, serious injury and cancer.  Opioid drugs can help manage some but not all types of chronic pain.

Examples of opioids include Codeine (including Co-Codamol), Tramadol, Fentanyl, Morphine and Oxycodone.

These medicines come in many different forms, such as injections, tablets, capsules, liquids and patches.

Why stop taking opioid medicines?

Opioids are strong pain-relieving medicines which are very effective for treating short-term pain after surgery or after an accident.  This is known as acute pain and usually lasts only days or weeks.

In the past, it was thought that opioids were useful for chronic pain (pain lasting longer than three months).  However, we now know and understand that opioids do not help long-term, chronic pain, and in fact are not safe to use for longer periods of time.  Long-term use of opioids can cause a range of side effects, addiction and even early death.

Oxycodone and Fentanyl are opioid medications which are even stronger than morphine.  It is sometimes useful to work out the morphine equivalent dose for people who are taking these drugs to highlight how strong these medicines are.

For example, 20mg of Oxycodone slow-release tablet is equivalent to 30-40mg of oral morphine a day and a Fentanyl patch 25mcg is equal to 60mg of oral morphine a day.

Current evidence highlights links between long term opioid use and tolerance and increased pain perception.  “Opioid tolerance and increase in pain perception may occur in patients taking opioids.  Opioid tolerance is likely if patients are taking more than 60mg of morphine a day, or its equivalent from other opioid medications, for 7 days or more (Neilson, et al. 2016; Colvin, Bull, and Hale 2019).  In fact, research from the USA shows that people who take more than 100mg of morphine equivalent per day have an increased risk of death, from overdose or side effects, compared to people who take no opioids or a very small dose.

Side-effects of opioid medications include the following:

  • Nausea
  • Vomiting
  • Constipation
  • Itching
  • Drowsiness

For further information on using opioids safely and a full list of possible side effects please refer to the patient information leaflet that came with your medicine and keep it handy.

Opioid medicines can cause some problems when you take them for a long time.  These problems include:

  • Constipation
  • Weight gain
  • Difficulty breathing at night
  • Increased levels of pain
  • Irregular periods
  • Opioid induced pain sensitivity
  • Itching
  • Lack of sex drive
  • Reduced ability to fight infection
  • Reduced fertility
  • Erectile dysfunction in men

Long-term use of opioids can lead to opioid-induced sensitivity.  This means that you can actually become more sensitive to pain.  You may notice that gentle touch can feel painful and that something that you would expect to hurt a bit, such as a needle may be extremely painful.  So, rather than helping to reduce your pain, the opioids can make your pain system more sensitive.

Stopping opioids completely can reverse this effect, so you may find that your pain gets better once you have stopped taking your opioids.

Can I drive when I am taking opioids?

In 2015 the law on drugs and driving changed, stating that if your driving is impaired for any reason, including taking prescribed medications, it is illegal to drive.

All opioid medicines have the potential to impair driving.  You are responsible for making sure you are safe on each occasion that you drive. The law in the UK allows you to drive if you are taking prescribed opioid medicines in accordance with the instructions, however

YOU SHOULD NEVER DRIVE IF YOU FEEL UNSAFE

How do I know if I am becoming addicted or dependent?

Will my body get used to opioid medicines?

Opioids can become less effective with time (this is called tolerance) meaning your body has got used to the pain-relieving effect of the medicine.  You can also become dependent on opioid medicine (dependence).  This means that if you stop taking the drug suddenly or lower the dose too quickly, you can get symptoms of withdrawal which can include the following:

  • Tiredness
  • Diarrhoea
  • Aching muscles
  • Sweating
  • Runny nose
  • Stomach cramps

What about addiction to opioids?

Addiction can happen gradually.  It can make you feel that you are no longer in control of how much medicine you need to take or how often you need to take it.  You might feel that you need to carry on taking your medicine, even when it doesn’t help to relieve your pain.

Talk to your doctor if your pain is becoming difficult to manage as your body may not be sensing its pain-relieving effect.  This is referred to as “opioid tolerance” and could be an early warning sign that you may be at risk of becoming addicted to opioid medications.

Signs that you may be addicted to opioids include:

  • Craving for the medicine
  • Feeling that you need to take more medicine than prescribed or as instructed on the medicine packaging, even if it is causing bad effects on your overall health
  • Feeling that you need to take additional medicines containing opioids or other pain relief medicines to achieve the same relief
  • Experiencing withdrawal side effects when you stop taking the medicine suddenly (see list below)
  • Taking opioid medicines for reasons other than pain relief

If you notice some or all of the above signs, please talk to your doctor or pharmacist for advice and support.

How can I safely stop taking my opioid medication?

If you have been taking your opioid medicine for a long time, do not stop taking it suddenly because this may cause unpleasant withdrawal side effects.  It is important to get the right help and support when you are ready to stop taking your medicine.

If you have taken opioids for less than two weeks, you should be able to stop these medications as soon as your prescribed course of medicines runs out, if not sooner.

Talk to your doctor, nurse or pharmacist.  They will be able to help you come off your opioid medicine slowly to reduce the unpleasant withdrawal side effects.  Safely coming off your opioids can take a long time.  Every person is different.  Take any unused opioids back to the pharmacist for safe disposal.

Withdrawal side effects may include a combination of the following:
Acceptance

Learn to accept that you may have chronic / persistent pain and begin to move forward.  This is often the most important step forward in helping to reduce and stop your opioid medicine.

  • Shivers
  • Sweating
  • Body aches
  • Diarrhoea
  • Widespread pain
  • Increased pain
  • Difficulty sleeping
  • Nausea and vomiting
  • Irritability and agitation

If you experience any of the above symptoms, then please talk to the person who prescribed your medicine or your doctor or pharmacist.

 It is important to build a support network of family and friends who can understand that this is an important but difficult process for you to do.  It can take a long time to stop taking your opioids altogether and to feel back to normal, so this ongoing support is essential to help you succeed.   The following section contains a list of resources and advice to help you manage the reduction and stopping of your opioid medicine.

Advice and Resources

 There are many resources which can help you to understand and manage your pain available to access on the Internet.  Listed below are some useful resources:

  •  The Pain Toolkit – Useful and practical guide for people living with persistent pain www.paintoolkit.org
  • British Pain Society – Professional group dedicated to understanding and the management of pain www.britishpainsociety.org
  • Pain UK – A UK charity dedicated to providing a voice to people with pain www.painuk.org
Useful video resources about pain:
References
  • If you experience side effects to your opioid medicines you can report these directly to the Medicines and Healthcare products Regulatory Agency on the Yellow Card website, via the free apps (‘Yellow Card Scheme’ in the Google Play Store or ‘Yellow Card – MHRA’ in the Apple App Store), or by phoning the free phoneline (0800 731 6789). 
  • Nielsen S, Degenhardt L., Hoban B, Gisev NA. Synthesis of oral morphine equivalents (OME) for opioid utilisation studies. Pharmacoepidemiol Drug Saf 2016;25(6):733-737. doi:10.1002/pds.3945 [doi] 
  • Colvin, L.A., Bull, F. & Hales, T.G. “Perioperative opioid analgesia-when is enough too much? A review of opioid-induced tolerance and hyperalgesia”, Lancet (London, England), 2019; vol. 393, no. 10180, pp. 1558-1568.
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