Starting Strong Painkillers – Commencing Opioid Painkillers

  • Reference Number: HEY-615/2014
  • Departments: Pharmacy

This leaflet has been produced to give you general information. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

Patient Name:

Date of Birth:

NHS Number:

Date:

Introduction

This leaflet has been produced to give you general information about your treatment. Most of your questions should have been answered by this leaflet.  It is not intended to replace the discussion between you and your doctor, but may act as a starting point for discussion.   If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.

Name of healthcare team member:  ………………………………………….

Telephone:    ………………………………

What is an opioid?

Your doctor has prescribed a new ‘stronger’ painkiller for you. This is a morphine-type painkiller, also called an opioid. These are being prescribed because your pain is not adequately managed by other simple painkillers (analgesics).

There are different opioids available as described below.

They can either come as a tablet/capsule/granule and will be available as a ‘slow release’ form taken every 12 hours to give a constant level of medication. They will be accompanied by a second form of the same medication as a ‘fast release’ tablet/capsule or liquid to provide extra rapid pain relief when necessary.

For patients with swallowing difficulties there are also opioid-containing patches available, which are applied to the skin and changed on the prescribed days. The medication is slowly absorbed (slow release) through the skin to give a constant level of medication. The opioid patches are also accompanied by fast release medication as above.

Why do I need opioids?

They are effective painkilling medications and taken correctly will provide pain relief to most patients. It is important, however, that you understand how to take your prescribed medication to gain the best pain relief and prevent side-effects.
You might be prescribed some different painkillers together with opioids, which will treat a different aspect of the pain.

The benefits of opioids

The aim of using these medications is to control your pain with as few tablets/ capsules/ patches/ granules or extra doses of liquid/tablets as possible. This is achieved by using a slow release opioid as your main medication and the fast release opioid to ‘top up’ in between the regular slow release doses if you have pain.

Fast release medication will have an effect approximately within 30 minutes of taking it and can last up to four hours.

There is no ‘right dose’ of an opioid and the dose we choose for you at the beginning will probably need to be adjusted to get it right for you. Your doctor or nurse will make arrangements for your dose to be reviewed at the hospital; at home; or at your GP’s surgery.

To do this, it is important that you keep a note of:

  • The dose of slow release opioid you are taking .
  • How many times you are taking the fast release opioid each day so your doctor or nurse can advise you of any necessary changes.

The name, form (e.g. tablet form) and dose of the medication prescribed for you are written below:

Slow release opioid: ……………………………………………………………………

……………………………………………………………………………………………

Fast release opioid: ……………………………………………………………………

………………………………………………………………………………………………

Special instructions: ……………………………………………………………………

………………………………………………………………………………………………

………………………………………………………………………………………………

Common side-effects of opioids

If you have taken opioids before please let your doctor know any problems you might have had.

Constipation

Opioids will make most people constipated and it is important that you take enough laxatives regularly to make sure that you open your bowels comfortably most days. Your doctor will prescribe laxatives for you; the name of the laxative is written below. If you feel these are not working well enough please let your doctor know and they may be able to prescribe a different type of laxative.

Your laxatives are: ………………………………………………………………………

Nausea

Some people will feel sick, nauseated or may be put off their food for a few days after they start taking opioids. This usually wears off but may be helped by anti-sickness tablets. Your doctor may prescribe some of these for you.

Your anti-sickness tablets are: …………………………………………………………

Sleepiness

Some people will feel sleepy or more tired than usual on starting to take opioids. This can be helpful if you have been having difficulty getting to sleep but you must not drive or operate machinery if you are affected. Please discuss this with your doctor if you are concerned.

If you experience any other effects, please discuss them with your doctor, pharmacist or nurse as they may or may not be due to opioids.

If since starting your opioid you cannot stay awake during the day time or have new breathing difficulties, please contact your doctor at your earliest convenience as the dose of your opioid may need adjusting or the opioid may need changing.

Storage of opioids

Store your opioid painkillers at room temperature in a safe place away from children and pets.

Follow up and further prescribing

We will ask your General Practitioner to issue further prescriptions of your opioid medication. Follow up arrangements will be discussed with you. You may need to come back to a hospital out-patient appointment or we may ask your GP to follow you up.

Frequently asked questions about opioid painkillers

Will I become a drug addict?

Patients taking opioid painkillers do not become addicted to them as their effect is used up in treating the pain. If the cause of the pain can be treated by other means, the dose of opioids can usually be slowly reduced without any undue side effects.

Will it help if I put up with my pain for now and save opioids until I really need them?

There is no benefit in saving an opioid painkiller for later as this may mean you have pain for longer. Please check with your doctor if there are any other treatments you can try which may help with your pain, as well as alternative types of painkillers. Sometimes these can be used together to keep the dose of opioids to a low but effective dose.

Are opioids not the ‘drugs of last resort’?

Opioids have a reputation for being drugs used as a last resort. This is no longer true and many patients have good pain relief with opioid painkillers for a long time. Please talk to your doctor, nurse or pharmacist about this if you still have concerns.

Can I still take my other pain killers with the opioids?

Most other painkillers can still be taken with opioids but you should tell your doctor which other medicines you are taking as it may be necessary to stop or change the dose of some of them.

Can I drink alcohol whilst I am taking opioid painkillers?

The drinking of alcohol whilst taking opioid painkillers is not discouraged but could make you sleepy and decrease the ability to concentrate. You will probably also be more sensitive to the effects of alcohol.

What about driving while I am taking opioid painkillers?

Opioids can make you drowsy and may affect your concentration and coordination. This would make you unsafe to drive. This is most likely to happen when you have just started taking opioid painkillers or when your dose has been increased and for some days or weeks afterwards.

If you are affected like this, you must not drive during this period and must make other arrangements. If this makes it difficult to get to hospital appointments, please talk to the nurses or other hospital staff who may be able to help with alternative arrangements.

As with all medication, remember to keep your opioid painkillers in a safe and secure place and do not allow people to take any of your medicine.

Contact details

Should you require further advice about the issues contained in this leaflet, please do not hesitate to contact:

Pharmacy Department – (01482) 461228.
Out of Hours – (01482) 875875, and ask for Bleep 500.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

  • you must be able to give your consent
  • you must be given enough information to enable you to make a decision
  • you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.