What is an opioid?

An opioid is a substance that blocks pain messages between the brain and the rest of the body. This can give you pain relief, but may also slow your heart rate and breathing.

There are 2 types of opioid medicines:

• opiates occur naturally and are made from the opium poppy (for example, codeine, morphine and heroin)
• opioids are created synthetically (for example, pethidine and fentanyl)

What are opioid medicines used for?

Most opioids, such as morphine and codeine, can be used to treat pain. Others such as methadone can also be used to treat addiction and manage withdrawal symptoms.

Opioids are prescribed for the short-term treatment of moderately severe or severe pain. This includes pain after surgery or an injury. They also help people manage pain caused by cancer and terminal diseases.

How do I know if my medicine is an opioid?

If you have been prescribed a pain relief medicine, ask your doctor or pharmacist if it is an opioid. This is important, since prescription opioids can cause serious side effects even when used exactly as prescribed by your doctor.

Opioids used to treat pain include:

• buprenorphine
• codeine
• fentanyl
• hydromorphone
• methadone
• morphine
• oxycodone
• tapentadol
• tramadol

Are prescription opioids effective for chronic pain?

Evidence shows that opioid medicines are not very useful for managing chronic non-cancer pain (also known as persistent pain). A person is considered to have chronic pain if they have constant or persistent pain lasting 3 months or more.

Learn about more effective strategies to treat chronic pain.

What are the short-term side effects of prescription opioids?

Prescription opioids can have side effects even if you use them exactly as your doctor recommends, including life-threatening breathing problems. The risk is higher:

• when you first start taking opioids
• after a dosage increase
• if you are older
• if you have an existing lung problem
• if you have reduced liver or kidney function
• if you take other medicines that have sedative effects, such as benzodiazepines

Other common side effects include:

• nausea and vomiting
• drowsiness or dizziness
• constipation
• loss of appetite
• dry mouth
• confusion and slurred speech
• slow and shallow breathing

These side effects can affect your ability to drive or operate heavy machinery safely. If you experience these side effects, it's important to avoid driving, as you may be at higher risk of having an accident.

You can reduce your risk of serious side effects while you are taking opioid medicines by:

• not drinking alcohol
• avoiding benzodiazepines, cannabis (marijuana) or illegal drugs

Always discuss any side effects caused by prescription opioids with your doctor. They will be able to help you manage the unwanted effects as well as helping you decide if you should continue taking prescription opioids. Your doctor can also help you find a different way to manage your pain.

What are the risks associated with long-term use of opioid medicines?

Evidence shows that the longer a person takes an opioid, the less pain relief they will receive. This is because the body gets used to the dose of opioid that's being taken. This is known as 'tolerance'. When a person develops tolerance to an opioid medicine, they need higher doses of the medicine to feel the same effect. But higher doses also increase the risk of serious side effects.

Long-term use of opioids can also make a person more sensitive to pain — this is known as 'opioid-induced hyperalgesia'.

It's also possible to become dependent on opioid medicines, meaning that if you stop taking them you may experience withdrawal symptoms and start craving (feeling like you need) opioids. Some people can become addicted to opioids, meaning they feel a compulsion (an overwhelming or strong need) to take opioids even if the medicine is having a negative effect. Symptoms of addiction include uncontrollable cravings and not being able to control your opioid use, even though it's having negative effects on personal relationships or finances.

Every day in Australia, 3 people die from opioid-related harm and nearly 150 people are hospitalised for the same reason.

What is naloxone?

Naloxone is a medicine that helps block the effect of opioids on the brain. It is widely used as an overdose-reversing medicine.

Naloxone will work for both prescribed and illegal opioids. It stays in the body for a shorter time than many opioid drugs. Naloxone works for around 30 – 90 minutes, while heroin and other opioids stay in the body for much longer (more than 12 hours, for some sustained-release opioids). If you take or give someone naloxone, be aware that the overdose can resume after the naloxone stops working.

It's common for people who have taken or been given naloxone to crave more opioids. Taking more opioids after taking naloxone could cause a second overdose and is especially dangerous.

What is being done to minimise the harm caused by opioid use in Australia?

The Australian Government is working with healthcare professionals to reduce harm caused by prescription and non-prescription opioids. Doctors carefully examine the reasons people are prescribed opioids and check if there are other treatments that could serve them better.

The number of doses of opioid medicines that are prescribed to people for short-term pain relief has been reduced. This aims to decrease the risk of harm from unused opioids. Larger pack sizes are still available for people who need them.

If you need opioid treatment 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, with the same pack sizes, as you do now.

If you need opioids for the long-term treatment of chronic non-cancer pain, your doctor will still be able to prescribe your opioid medicines. In some situations, your doctor may refer you to a pain specialist or a different prescriber for a clinical review. Talk to your doctor for more information.

How can I minimise the risks associated with opioid use?

If you are taking prescription opioid medicines, there are ways to help keep yourself safe:

• Only use medicines that have been prescribed for you, and take them exactly as your doctor prescribed them.
• Avoid alcohol, benzodiazepines, cannabis, or illegal drugs while taking opioid medicines.
• Learn how naloxone can be used to reverse an overdose (including accidental overdose) and share this information with people at risk, and people who live with them.
• Discuss any side effects you experience with your doctor.
• Talk to your doctor if you are taking prescription opioids but still have pain. Your doctor may be able to suggest other options for pain management.

If you have opioid medicines at home that you don't need anymore, ask your doctor or pharmacist how you can dispose of them safely.

When should I see my doctor?

If you are taking a prescription opioid, you should check in with your doctor regularly to make sure it is still the best treatment option for you.

If you feel the opioid you were prescribed is not helping with your pain, it is important to discuss this with your doctor. Your doctor may recommend a different approach to managing your pain. They can also advise you about gradually reducing the dose of your opioid medicine ('tapering') to reduce the risk of withdrawal symptoms. Don't change the dosage you are taking without speaking to your doctor first.

If you want to stop taking an opioid medicine, discuss the safest way to do this with your doctor.

Are you concerned about someone else taking prescription opioids?

If you are concerned about someone else who is taking opioid medicines, you may feel uncomfortable raising the issue with them. Show the person you are speaking to that you have their best interests in mind. Encourage them to seek support from a doctor who will consider all of the options available to treat pain. This may include non-medicine-based options.

You can find information and support services for the person affected and/or for yourself, using the Alcohol and Drug Foundation Path2Help service.

Resources and support

• Call 1300 MEDICINE (1300 633 424) to talk to pharmacists about the medicines you are taking for your pain.
• Discuss your pain on the Pain Link helpline (1300 340 357), which is staffed by volunteers with personal experience of chronic pain.
• Visit Painaustralia to find pain services and programs in your area.
• Learn more about managing pain and prescription opioids at Choosing Wisely Australia.