What are opioids?

Opioids are a group of strong pain medicines. Opioids reduce the feeling of pain by interrupting nerve signals between the brain and the body. They also increase the amount of a natural brain chemical called dopamine, which causes you to feel less pain and more pleasure.

Opioids also include some illegal substances, such as heroin.

What are opioid medicines used for?

Opioids can help relieve acute (short-term) pain — for example, after a recent injury or surgery. It's best to use the lowest dose that helps you, usually just for a few days.

Opioids can also help people with cancer pain and those receiving palliative care.

Evidence shows that opioid medicines are not very useful for managing chronic (long-term) non-cancer pain. The longer you take an opioid, the less pain relief you will feel over time. Long-term use of opioids can also make you more sensitive to pain. However, sometimes opioids are prescribed for chronic pain if nothing else helps.

Some opioids, such as methadone, can be used to treat addiction to other opioids. They are prescribed as a substitute for more harmful opioids, such as heroin. This reduces the risk of harm and makes it easier to stop taking opioids.

What's the difference between acute and chronic pain?

Acute pain is short-term pain, such as pain from an injury that develops quickly and is usually temporary. It can last a few minutes or a few weeks. It goes away when the injury heals.

Chronic pain lasts for more than 3 months, or for longer than healing is expected to take, depending on the cause. It can result from changes in your nerves that cause your body to produce pain signals even after an injury has healed. Examples of chronic pain include pain caused by illnesses such as migraine, cancer or arthritis. It can develop after an injury or surgery. Sometimes there is no known cause.

What are the risks of opioid medicines?

Opioids can cause unwanted side effects, including:

• drowsiness
• nausea
• constipation

Opioids may make it difficult for you to drive, care for children, or operate heavy machinery.

If you take an opioid medicine for a long time, you may become dependent on it and have difficulty stopping. You might also develop depression, sleep apnoea or sexual and fertility problems.

What should I ask my doctor about my pain medicines?

It's important to have information about your pain medicines. Ask your doctor or pharmacist about:

• the type of pain medicines you have been prescribed
• how and when to start and stop taking them
• how they are expected to help you
• what side effects you might experience
• what to expect if you stop taking your medicines
• whether there are any other options to relieve your pain

ASK YOUR DOCTOR — Preparing for an appointment? Use the Pain Question Planner to prepare for your doctor’s appointment.

Can I become pain free?

Pain is complex and everyone experiences it differently.

Acute pain usually goes away when the injury that caused it has healed. However, sometimes it can turn into chronic pain.

Chronic pain may not go away completely, but it can often be reduced. Many people can learn to live with chronic pain.

What do 'tolerance' and 'dependence' mean?

If you use pain medicines containing opioids for a long period of time, you could develop tolerance or dependence.

Tolerance means that your body gets used to the medicine, so it doesn't work as well as it did in the past. You may need to take larger amounts of medicine to get the same effect.

Dependence means that you have trouble stopping the medicine. It's likely to occur if you have been taking an opioid for more than 4 weeks. Dependence can be physical, psychological or both.

Physical dependence is when you experience physical withdrawal symptoms if you suddenly stop taking the medicine. This is simply the way your body responds. It does not mean you are addicted to the medicine.

Psychological dependence is when you can't control your need to keep taking the medicine, even if it is causing problems. This is also known as 'opioid use disorder' or addiction.

Could I become addicted to my pain medicines?

Pain medicines that contain opioids can be addictive if you take them for a long time. The higher your dose of opioid medicine, the higher your risk of addiction (or opioid use disorder).

Symptoms that you might have opioid use disorder include:

• feeling strong cravings to take opioid medicines
• taking more medicine than you had planned
• spending a lot of time and effort trying to get hold of more medicine
• struggling with work or daily activities because of your opioid use

You can develop opioid use disorder even if you take your medicines as prescribed by your doctor.

If you find you are using opioids for reasons other than pain — for example, to help with stress or sleep — you may be developing a problem with your opioid use.

WORRIED ABOUT YOUR OPIOID USE? — The Opioid Risk Indicator can help you find out if you may be developing a problem.

How should I stop taking my pain medicines?

Always talk to your doctor or pharmacist before stopping your pain medicine.

If you've been taking an opioid medicine regularly for a few weeks, you may experience temporary withdrawal symptoms if you stop taking it suddenly.

To reduce withdrawal symptoms, your doctor may reduce your dose slowly over several days or weeks. This is known as 'weaning off' or tapering a medicine.

While tapering your medicine, you should see your doctor regularly for review.

What pain medicines can I take instead of opioids?

Depending on what is causing your pain, there are many other types of pain medicines you might try, including:

• paracetamol
• non-steroidal anti-inflammatories (NSAIDs)
• antiepileptic medicines
• antidepressants
• supplements such as fish oil

Talk to your doctor if your medicines are not helping you manage your pain, if you find you need to keep increasing your dose, or if you're experiencing side effects.

Are there other ways to manage my chronic pain?

Medicines alone are not the most effective way to treat chronic pain. It's best managed using a combination of different approaches.

This might include pain relief medicines, as well as:

• physiotherapy
• exercise
• heat packs
• massage
• relaxation techniques
• mindfulness
• cognitive behaviour therapy

Will the recent changes to opioid laws affect my access to pain medicine?

Due to recent legislation, opioid medicines now come in smaller pack sizes. This means people with acute pain can receive just enough medicine for a few days, without having leftover opioid doses that could be used in a harmful way.

Larger pack sizes are still available for people who need them.

If you need to take opioid pain medicine for a long period of time, such as if you have cancer or are receiving palliative care, you'll still be able to receive your medicine in the same way as you do now.

If you need to take opioids long-term to treat chronic non-cancer pain, your doctor will still be able to prescribe your opioid medicines. However, they might talk to you about other pain relief options.

If you're worried about how these changes may affect you, talk to your doctor for more information.

Where can I get more information and support?

Call of visit one of these organisations for more information on opioid medicines, or for counselling and support:

• Call 1300 MEDICINE on 1300 633 424 to talk to a pharmacist about your pain medicines.
• Call the Pain Link Helpline on 1300 340 357 for support and tips from people with personal experience of chronic pain.
• Visit painHEALTH for information, personal stories and tips to help with management of musculoskeletal pain.
• Visit Palliative Care Australia for support for people with pain during palliative care.
• Learn about opioid dependency and get support at Reach for the facts.
• Visit the Therapeutic Goods Administration (TGA) for information about prescription opioids and changes to legislation.
• Access online courses to help you manage chronic pain at THIS WAY UP. These courses may be free, if you have a referral from your doctor.