Patient Information: Opioids - City View Medical Practice

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Patient Information: Opioid Prescribing and Requests for Chronic (Long Term) and Acute (Sudden) Pain.

Opioids are the strongest painkillers we can prescribe and include codeine, dihydrocodeine, morphine, oxycodone, buprenorphine and fentanyl.

Opioids should be considered for pain management only when all other medication and non-medication options have been explored. For further information on pain management, please access the following websites: https://www.flippinpain.co.uk and https://www.livewellwithpain.co.uk.

When you may need an opioid for acute pain

Opioids can be helpful initially in reducing the feeling of pain in acute situations, such as after an injury where you may have broken a bone. They may be used in hospital after major surgery as the injury repairs.

Opioid prescriptions for acute pain will not exceed 7 days' supply. This is the expected duration of pain severe enough to require opioid medication.

Sometimes, a prescriber may deem it more suitable for an opioid to be prescribed for you (for example if you are elderly, or when anti-inflammatory medicines may not suitable). If this is you, your prescriber will prescribe the minimum effective dose of an opioid for a specified period of time, with advice on planned follow-up before any further prescriptions are issued.

When you are suffering from chronic pain

For chronic pain, the benefits of opioids are limited. Recent clinical evidence shows that the use of opioids for the management of chronic pain is ineffective and has the potential to be harmful.^[1]

We understand that chronic pain can have a severe impact on your quality of life and many people who suffer from chronic pain long for a quick solution to stop pain completely. The purpose of this policy is to advise you that long-term opiates are often not the solution.

Chronic pain is complex and there are other factors which can contribute to it. Some of these may be physical; others may be emotional or social. If you think there may be other factors contributing to your pain, please arrange a routine appointment with your prescriber to discuss this further.

Understanding tolerance and increased pain

However, when opioids are prescribed for only a short period of time, the body does not have time to adapt and therefore you experience pain relief. This initial feeling of relief is often experienced when the dose or strength of the opioid is increased.

When taken regularly for a long time, you will find the relief from the pain is only short-lived and may wear off completely. This is because the body gets used to the medicine, so it stops giving the same effect. This can lead to an individual believing they need more regular doses and higher strengths. Taking higher doses and strengths of opioids can result in potentially harmful effects to your body.

Addiction

Opiate medication is addictive. It is unusual for someone with short-term pain to become addicted to opioids if they follow the prescribing advice, however, longer term use of opioids can lead to dependency, and potentially to addiction.

If you believe you are addicted to opioid medication, then please arrange an appointment with a GP or Pharmacist at the surgery. We would not advise stopping your opioid medication abruptly.

Further information can also be found at https://www.forwardleeds.co.uk.

Potential side effects and risks

When you first start taking opioid-based medication, some people get side effects such as:

Dizziness
Drowsiness
Nausea and/or vomiting
Confusion

These symptoms normally settle after a few days. Other ongoing side effects of opioids include:

Constipation (not being able to poo) that can require laxatives
Reduced libido (sex drive), erectile dysfunction and irregular periods
Itchy skin
Weight gain
Reduced fertility
Increased levels of pain
Mood changes and/or agitation
Loss of interest and concentration
Difficulty breathing, especially at night

Respiratory depression (slow and ineffective breathing) can occur in opioid overdose, which can lead to death. The risk is greatest when more than one opioid is prescribed, or when an opioid is prescribed in higher doses, or with other drugs that affect breathing, such as benzodiazepines or gabapentin or pregabalin.

Driving

See https://www.gov.uk/drug-driving-law for information on driving when taking prescription medicines such as benzodiazepines.

These medications can cause drowsiness, dizziness and impaired cognitive function (thinking and judgement). They may affect your ability to drive safely.

Alcohol

Alcohol increases the sedative (sleepy) effects of opioid medication. It is best not to drink alcohol when you start taking opioid medication.

Prescription requests

Lost prescriptions will not be replaced.
If you take higher doses than prescribed and run out of medication before the next prescription is due, you will NOT be prescribed extra tablets. A routine appointment with a clinician to discuss this further is advised.
These medicines are controlled drugs and will not be prescribed early.
Prescriptions requested early for travel will require proof of travel.
Prescription requests take up to two full working days to action. The request will be fulfilled only if it is appropriate to prescribe.

If you have any further questions regarding this information, including the ongoing management of your condition, then please arrange a routine appointment to discuss further with your prescriber.

If you are taking this medication regularly and you wish to reduce or stop it, please contact us to arrange a routine appointment with your prescriber.

Please do not stop your medication suddenly, as this may make you feel unwell.