Information for patients and carers
For patients who are prescribed strong opioid medications e.g. morphine, oxycodone and fentanyl
What are strong opioids?
Strong opioids are powerful medicines used to control pain that has not been controlled by weaker pain medicines. This can occur in a number of situations including after operations and for illnesses such as cancer. They can also reduce the feeling of breathlessness in patients with severe lung problems.
Types of strong opioids
Most patients are prescribed a ‘Modified Release’ preparation e.g. Zomorph to keep the pain under control and an ‘Immediate Release’ preparation e.g. Oramorph to be used when pain occurs.
Modified Release (MR) Opioids
These are ‘long acting’ opioids which come in a variety of strengths and forms. Modified release medication is released slowly into the body to provide pain relief throughout the day and night. Each oral dose lasts for twelve hours.
Modified release morphine and oxycodone should therefore be taken every 12 hours to keep a stable level of medicine in your body e.g. 8am and 8pm.
It is not suitable to be taken for any breakthrough (sudden/extra) pain between these doses because it is too slow to start working and to wear off.
Fentanyl patches are another type of long acting strong opioid. (See ‘Fentanyl’ information leaflet).
Immediate Release (IR) Opioids
These are ‘fast acting’ opioids suitable to be taken for ‘breakthrough’ pain because they act quickly. Most work 30 minutes to 1 hour after taking a dose and usually last for about four hours. If the medication has not worked after 1 hour, a second dose can be taken.
If you are needing more than 2-3 extra doses each day, tell your doctor or nurse as it may be necessary to increase the modified release opioid.
Fast acting opioids may also be prescribed at regular intervals throughout the day when you first start strong opioids to help decide what dose of modified release opioid you need. Other fast acting opioids include Sevredol tablets and oxycodone IR e.g. Oxynorm liquid or tablets.
How will you choose which drug I take?
The majority of patients will be given morphine as their strong opioid pain medicine. Oxycodone and fentanyl are alternatives and may suit some people better depending on individual circumstances and response to treatment.
You may also be offered other medications alongside a strong opioid to get best control of your pain e.g Paracetomol.
Monitoring
You will need to be followed up by a nurse or doctor to monitor your pain, the response to medication and any side effects. Your dose may be adjusted accordingly. It may help to keep a record of any breakthrough pain and extra doses used to guide you and your doctor or nurse regarding changes in medication.
Repeat prescriptions
Order this from your GP surgery in good time so that you do not run out. Remember to re-order after dose changes as tablet strengths may also change.
Possible side effects
Constipation
Almost everyone will become constipated with morphine or oxycodone. Taking a prescribed laxative regularly is important to prevent this.
Drinking plenty of fluid and eating fruit and vegetables can also help.
Nausea and vomiting
Some people taking opioid medicines can feel sick and may vomit after starting them or after an increase in dose. This usually settles within 2 weeks. Try taking with food or ask your doctor to prescribe an anti-sickness medication.
Drowsiness
People can feel drowsy for a few days after starting opioid medication or following an increase in dose. For most people this quickly wears off. If it affects you, you should be careful not to drive or operate dangerous machinery at this time.
Precautions
The following symptoms require a prompt review by your doctor or nurse:
- Feeling more sleepy than usual
- Feeling sick most of the time
- Restlessness or jumpiness
- Bad dreams/hallucinations
- Confusion.
You may need to have your medication reduced, have a blood test or take other treatments for your pain.
Do not stop taking opioid medicines suddenly as this will also give you side effects. (See ‘Fentanyl’ information leaflet for extra precaution information for fentanyl).
Without a strong opioid, it may be difficult to control your pain. Uncontrolled pain can have a negative impact on your whole life by affecting your emotions, mood and relationships. Good pain control makes you more able to do things and can improve the quality of your life.
Used correctly, there is no evidence that using strong opioid medicines shortens your life or causes addiction.
Safe storage
Your medication needs to be kept in a safe place out of the reach of children. It needs to be stored in the original container. Return unused medication to a pharmacy.
Frequently asked questions
Take a dose as soon as you remember. Do not take a double dose for the missed one. If you vomit the medication, repeat the dose once you feel better.
The combination of strong opioids and alcohol may make you feel sleepy or drunk sooner than usual so it is sensible to drink much less than you are used to until you know what effect it has on you.
No. The right time to start strong opioids is the time when you have pain bad enough to need them. This is not affected by how long you are going to live for.
You will be able to continue to take these medicines for as long as they are needed.
Sometimes it is necessary to steadily increase the dose of pain medicines, particularly when starting, in order to get the correct dose for you.
Further increases in dose may be needed if the pain gets worse. The effects of strong opioids do not wear off over time.
No. These are very good pain medicines but they do not work for all pain. Sometimes you will need to take other pain relief treatments suggested by your doctor or nurse, either with, or instead of, a strong opioid.
Taking strong opioids does not mean that you cannot drive. You should discuss with your doctor, use common sense and re-assess following any medication changes.
If you and your doctor decide you can drive remember to avoid driving;
- After starting or changing the dose of medication
- If you feel drowsy or unwell
- After taking an immediate release opioid
- If you are in pain.
Try to avoid long distances and dark or bad driving conditions.
If you or your doctor are concerned that your ability to drive is affected by your illness or treatment, then you should inform the DVLA and your insurance company.
Based on the Northern Devon Healthcare NHS Trust leaflet – Oral Morphine for Palliative Care 2012
DO NOT DRINK ALCOHOL OR DRIVE WHILST USING THIS MEDICATION