Safe opioid use for pain patients

What you need to know

Pain patients

Many people are prescribed medications containing opioids for treating pain, often after an injury or surgery. Most opioids are used to treat pain that is moderate to severe. Mild (low-level) pain can usually be treated with non-opioid medications like paracetamol, aspirin and ibuprofen.

As opioids are sold under brand names that don’t tell you what the medication contains, many people who are prescribed these drugs don’t realise  they are actually taking an opioid. Many people also don’t realise that medicines prescribed by their doctor can be dangerous.

If your doctor has prescribed an opioid for you, this guide will tell you what you need to know to keep safe and avoid developing a dependence or addiction.

Opioid medications should only be used when they have been recommended or prescribed by a healthcare professional. Situations when you may be prescribed opioids include:

  • If you have been injured or following a surgery
  • If you have chronic pain caused by cancer or other conditions
  • If you are receiving medication-assisted treatment for opioid dependence
  • It may seem odd, but some opioids are used to treat opioid dependence or Opioid Use Disorder. This is often called medication-assisted treatment (MAT), opioid substitution/replacement therapy, or pharmacotherapy. There’s more on that in the section on medication-assisted treatment.

If your doctor prescribes opioids, it’s always a good idea to ask about the medication and any possible risks from using it.

You should also speak with your doctor if your current medication is not treating your pain effectively or if you’re having problems with side effects.

Opioids are an excellent treatment for short-term pain, like the pain you might have after an injury or surgery.

But opioids can make you more sensitive to pain over time, so they may not be the most effective way to treat pain in the long term. Being more sensitive means you need larger doses to reduce your pain, which increases the risk of dependency and overdose.

If you’re taking opioids to manage your pain, there are other options that may work for you. You can talk to your doctor or a pain specialist to learn more about these.

Non-opioid pain medications such as paracetamol, aspirin and ibuprofen are known to be as effective as opioids in treating some kinds of acute (short-term) pain. But for some people, their pain will be so bad that opioids are the best option.

Medicinal cannabis may also be effective in the management of some types of pain. Laws about medicinal cannabis vary widely so ask your doctor about this if you’re interested.

Other types of treatment for pain include:

  • physiotherapy
  • exercise
  • counselling
  • non-opioid medication
  • meditation
  • acupuncture

‘Multidisciplinary pain management’, or the use of more than one type of pain therapy at the same time, is proven to be more effective at relieving pain than medication alone. If your doctor has prescribed a pain medication, other pain management treatments (like light exercise and/or physiotherapy) may reduce the time that you need to spend taking opioids.

Be sure to ask your doctor what else you can do to support your recovery.

Other holistic or natural pain therapies, like aromatherapy or hypnosis, may be recommended to help you manage your pain. While there isn’t much evidence that these work as treatments for pain, you may find that things like aromatherapy are still helpful or pleasant. These can be combined with other types of treatments that have been proven to work in reducing pain.

Your mood can also affect the way you experience pain. Making sure you’re comfortable, calm, in a familiar place and in contact with loved ones can help with managing pain.

Of course, if your pain is causing you a lot of distress, you should see a doctor so it can be treated in a way that’s best for you.

While we know that opioids are effective at relieving pain in the short term, some doctors prescribe them when other pain therapies may be more suitable. Over-prescribing of opioids is increasing, notably in many parts of the world including Canada, the US, Europe and Australia.

If you’re unsure if opioids are right for you, ask your doctor about alternatives or see another doctor for a second opinion.

Seeing a healthcare professional who specialises in pain management is also a good way to make sure you’re getting the best treatment.

Remember: you do not have to take opioids if you don’t want to.

It’s important to store all medications safely, especially opioids. Make sure they’re kept securely – preferably locked – in a place where they can’t be reached by children, pets or other people.

Do not keep them on a bedside table, in the glove compartment of your car or in the bathroom cabinet.

Exposure to opioids poses a serious risk to the health and safety of children, pets and anyone who hasn’t been prescribed opioids.

Getting rid of leftover medications is also important. Keeping medications you no longer need increases the risk that you or other people will take them. Most chemists or pharmacies will take your leftover medications. Just give them to your pharmacist and ask them to take care of them.

If you’re unsure whether you should get rid of your opioid medication when you no longer need it, ask your doctor or pharmacist. If you have no medical reason to take opioids, it is important that you don’t. It’s also important not to give or sell opioids to other people. If you do, you’re putting yourself and others at risk of developing dependence or addiction and possibly overdosing. You may also be breaking the law.

People who take opioids for a medical condition can become dependent on (addicted to) them. Being dependent means that your body is used to having opioids in your system and needs them to function properly. Opioid dependence can be very hard to deal with; the best way to deal with it is with help from a doctor.

If you’re dependent on opioids, stopping or reducing the amount you take can cause physical and psychological withdrawal symptoms.

You should not attempt to stop taking opioids or reduce the amount you’re taking without consulting your doctor.

There’s a range of signs that suggest someone may be dependent on, or addicted to, opioids. Most of these are physical symptoms that the individual person experiences, but they can also include changes in the person’s behaviour.

Signs of opioid dependence or addiction include:

  • Needing a higher dose to get the same effect
  • Taking more opioids or taking them for longer than planned
  • Spending increased time and effort getting opioids
  • Experiencing withdrawal if you stop taking opioids or reduce your dose
  • Reducing the time you spend on other activities like work, sport or family
  • Continuing to take the medication even though it’s causing you problems

If you think you might be becoming dependent on, or addicted to, your opioid medication, ask yourself the following questions:

  • Am I taking more than the prescribed dose?
  • Am I taking opioids for something other than for what they were prescribed?
  • Am I going to the doctor more frequently to get the amount of medication I need?
  • Am I getting opioids through methods other than my regular doctor?
  • Do I feel like my pain or mood get worse if I don’t take my medication?
  • Do I get anxious about the idea of not taking my medication?
  • Do I need the medication to function in daily life (beyond just relieving pain)?
  • Am I using different methods to take opioids (i.e. snorting, injecting)?

If you answer yes to any of these questions, you may want to speak to your doctor.

There are lots of ways to reduce your chances of developing opioid dependence and addiction. Knowing and paying attention to the factors that may contribute to opioid dependence and addiction is a good start.

These include:

  • History of dependence or misuse of opioids or other drugs
  • History of mental illness
  • Chronic pain
  • Childhood trauma
  • Being prescribed higher doses of opioids for a longer time

Anyone can become dependent on opioids but these are known factors that increase your risk. Not everyone who has chronic pain or a history of misuse will become dependent.

Dependence and addiction are also highly stigmatised so people who are dependent or addicted may experience discrimination from other people, health services or police. This can make people feel ashamed and prevent them asking for help. Dependence or addiction is a medical condition that many people struggle with. You should not be made to feel ashamed for experiencing dependence or seeking help.

People who are dependent or addicted still have the right to have their pain treated and to be given the best healthcare for their needs.