Prescription opioids

Prescription Opioids

 

Prescription opioids can be effective when used in the short-term to manage severe pain. When they’re used for long-term, the risks of developing opioid dependency increase.

 

It’s best to use prescription opioids for the shortest time you can, and talk to your doctor about reducing your dosage as soon as possible.

 

Prescription opioids are one of the biggest contributors to the increasing number of overdose fatalities in Australia.

Getting to know prescription opioids

 

Opioids explained

Prescription opioids

 

Pharmaceutical opioids are medications commonly used for pain. According to the National Drug and Alcohol Research Centre, opioids are depressants which modify the activity of the central nervous system and messages going between the brain and body. Common opioid medications include:

 

+ oxycodone (brand names include OxyContin, Endone or Targin)

+ morphine (brand names include MS Contin or Kapanol)

+ codeine (brand names include Panadeine Forte or Nurofen Plus), and

+ fentanyl (brand names include Durogesic, Fentanyl Sandoz Patches)

 

Opioids have an important role in surgical pain, end-of-life care and some severe short-term painful conditions. They have very limited to no role in ongoing pain conditions where other strategies are more effective and/or more safe to use.

The role of opioids in pain management

Prescription opioids have an important role in surgical pain, end-of-life care and some severe short-term painful conditions.

 

When prescription opioids are used in the short time to manage ‘acute’ pain from an injury or surgery, they can be very helpful in reducing pain. When used for less than a week or two, there is less risk of becoming dependent on these medications as well.

 

However, when prescription opioids are used in the long-term, there’s little evidence that they are effective pain relievers at all. For people with pain lasting for three months or longer (chronic pain), research shows that prescription opioids are less effective than other approaches to manage pain. In fact, there is evidence long-term use of opioids can actually increase pain.

 

You can read more in the next tab ‘Managing chronic pain’ to find out about other more effective alternatives to manage long-term pain.

Managing chronic pain

Understanding pain

 

Pain management is a complex issue. Although we often think of pain as something that is purely physical, it often has other components that are social, psychological, behavioural and financial.

 

We know, based on scientific evidence, that pain (and particularly long-term or chronic pain) usually requires a multidisciplinary approach to help individuals go on with their daily lives.

 

It’s important to remember that effective pain management may not always just involve using medications, and there are many different non-pharmaceutical therapies available which you can discuss with your pharmacist, doctor or other health professionals such as physiotherapists or psychologists.

Types of pain

 

Although there are many different types of pain, the two most common types are acute pain and chronic pain.

 

Acute pain

 

Characteristics of acute pain:

+ Generally lasts for a short time (usually less than three months)

+ Usually happens after an injury of some kind

+ Often goes away on its own

 

Chronic pain (or persistent pain)

 

Characteristics of chronic pain:

+ Generally lasts for longer than three months

+ Chronic pain is complex and can happen when there’s no clear injury

+ Can cause changes in the central nervous system

 

NPS MedicineWise has a comprehensive explanation of chronic pain and its treatment which you can access here.

 

You can also watch more videos about pain on ScriptWise’s YouTube ‘pain management playlist here.

Risks of using prescription opioids long-term

 

Side-effects

Side-effects

 

Some of the potential side-effects associated with using opioid medications include:

 

+ Constipation

+ Nausea

+ Dizziness

+ Dry mouth

+ Sleepiness

+ Headaches

+ Difficulties breathing

+ Dependence

Dependence

Prescription opioid dependence

 

It is possible to become dependent on opioid medications without realising it.

 

The body can develop a tolerance which lessens the medication’s effectiveness and means more and more is needed to get the same pain relief.

Potential warning signs of opioid dependence

 

Here are some of the warning signs that you, or someone you know, may be experiencing dependence:

 

+ Using more and more medication to get the same pain relief

+ Being unable to stop taking or take less medication

+ Feeling sick when you try to stop taking the medication (e.g. being shaky, anxious, sweaty or experiencing stomach pain)

+ Making excuses to get the medication

+ Negative life experiences in general (e.g. being late/absent from work, relationship problems, losing interest in everyday activities)

 

If you answer yes to any of the following questions,  you may be at risk of dependence and it’s important to speak with your GP.

 

– Do you find that you’re taking more than the prescribed dose of medication to treat your pain?

– Do you feel that you’re having to go to more than one doctor frequently to get the amount of medication you need?

– Do you feel that your pain and your mood actually get worse if you don’t take your medication?

– Do you feel judged or ashamed when a pharmacist wants to discuss how much medication you have been buying?

– Do you begin to feel highly anxious about not being able to get to your medication and that you need it to function in daily life?

Prescription medication dependence is a medical condition that can happen to anyone, and there is no shame in seeking treatment for it.

If you answered yes to any of the questions above, ask your GP about the many very effective treatments available.

Withdrawal

Prescription Opioid Withdrawal

 

Once you have become dependent on prescription opioids, if you reduce the amount of opioids you’re using, or stop using them suddenly, withdrawal symptoms can occur.

 

Common withdrawal symptoms include:

+ head and muscle aches

+ mood swings

+ insomnia

+ nausea

+ diarrhoea

Overdose

Overdose involving prescription opioids

 

Too many Australians are dying due to prescription medication overdose involving prescription opioids. Prescription medications, not illicit drugs, are responsible for the highest number of drug-induced deaths in Australia. In 2016, prescription opioid and benzodiazepine related drug deaths outnumbered the road toll in Australia.

 

 784 Australians died due to a prescription opioid induced death (codeine, oxycodone, fentanyl, tramadol or pethidine) in 2016.

 

It is important to understand that opioid medications, particularly in high doses and in combination with other medications, can slow breathing and cause overdose.

 

The majority of overdose deaths in Australia are accidental.

What is an overdose?

 

Prescription opioids, particularly when combined with other central nervous system depressants, can act to slow down a person’s breathing and heart rate.

 

An overdose happens when these medications reduce the body’s natural urge to breath and stop someone from breathing. This can lead to brain damage or death.

 

According to the Penington Institute, signs of an overdose can include:

+ No response to stimuli

+ Shallow/stopped breathing

+ Can’t be woken up

+ Unusual snoring/gurgling sounds

+ Blue/grey lips or finger tips

+ Floppy arms and legs

Treating an overdose

 

Naloxone

 

Naloxone is a temporary antidote to an opioid overdose: it reverses the overdose and allows a person to breathe again. It buys the person time for an ambulance, or other medical help, to arrive.

 

Naloxone is easy to use and needs to be administered by someone who is with the person who has overdosed. It can be bought from a local chemist or you can get a prescription from a doctor.

 

Naloxone can be bought by anyone, and there are no risks associated with using it. If someone you know is at risk of an opioid overdose, it can be good to discuss naloxone with them, and to have it in your cupboard and feel safe to use it if needed.

 

The Penington Institute has some excellent resources explaining how to use and access naloxone, including training. You can also speak to your pharmacist or your doctor about naloxone.

Getting effective treatment

 

Treatment options

Treatment options

Visit your GP

 

If you are concerned about your opioid use, it is important to first talk with your prescriber (usually your GP) to make a plan to safely reduce or stop your medication.

 

While stopping using your medications suddenly (going ‘cold turkey’) is not dangerous, your doctor can guide you through this process, and help you to come up with a plan that suits your needs. This may involve reducing your medication over time (‘deprescribing’) or using medication-assisted treatment. You can read more about these two treatments in the following tabs,

 

Counselling

 

It can also be beneficial to receive counselling while reducing your medication or beginning medication-assisted treatment.

 

Counselling can help to address any underlying issues which may have been masked by opioid use, and help to process emotions which may have been suppressed by the medications. It can also be very important to develop the necessary strategies and tools to use if you do have opioid cravings.

 

You can visit your GP to get a Mental Health Care Plan to see a psychologist with a Medicare discount, or you can choose to see a psychologist or psychiatrist privately.

 

Reconnexion also have some great resources to find out more about this process, and a helpline in Victoria you can call to arrange counselling or a secondary consult with your GP should they need assistance. You can call Reconnexion on 1300 273 266.

Reducing your prescription opioid use

Reducing your opioid use (‘deprescribing’)

 

Your prescriber will likely speak to you about what your main health concern is and how to address it. If your main health problem is managing chronic pain, your GP will likely explain that long-term use of opioids to treat persisting pain isn’t recommended. This is because there is little evidence that they are effective, and that there are other alternatives available which are evidence-based.

 

Your GP will likely then speak to you about developing a plan to slowly wean off your medication over time. The time this can take varies depending on how long you have been on your medication, how high your dose has been, and also how comfortable you are with the reduction process.

Medication-assisted treatment

Medication-Assisted Treatment

 

If you and your GP decide that your main health concern at the moment is opioid dependency, your GP might also speak to you about using very effective medications to reduce opioid cravings and help you get back to your daily life.

 

There are two main medications used to treat opioid dependency: methadone and buprenorphine (with or without naloxone).

 

Both of these medications help to prevent opioid withdrawal and cravings and give people the chance to get back to living their lives.

 

Initially, people who are receiving treatment will need to visit a pharmacy or recognised clinic once a day to receive this medication. After your doctor helps you to determine when it’s safe to do so, you may also be able to receive take-away doses.