Opioid painkillers and painkilling patches

Opioid painkillers can be prescribed to offer relief from moderate to severe pain when other forms of pain relief haven’t worked.

Some opioids are stronger than others. If your doctor feels your pain can only be helped by opioids they will prescribe the lowest dose, for the shortest time. Opioids are available as tablets, liquids, or patches.

However, because of the risk of side effects such as addiction and overdose, healthcare professionals are advised to avoid prescribing opioid painkillers for long-term pain, where possible. If you are prescribed opioid painkillers your treatment should be strictly monitored.

If you think your pain medicines aren't helping with your symptoms, or are causing unpleasant side effects, it might be a good idea to reduce or stop them. Discuss with your doctor how to minimise the risk of any withdrawal symptoms. This could include gradually reducing the dose, and having regular reviews with your healthcare team.

Opioid painkillers include:

• codeine
• dihydrocodeine
• tramadol
• buprenorphine
• fentanyl
• morphine
• diamorphine
• oxycodone
• tapentadol.

The low-dose codeine used in compound painkillers is the only opioid painkiller available without a prescription.

Opioid patches

Your doctor may consider prescribing you a course of treatment with opioid patches if you’ve tried a low-dose opioid, such as morphine, and you’re still in pain.

These patches usually contain either buprenorphine or fentanyl, which is slowly released into the body over a period of several days. For guidance on how often you should change your patch, see the patient information leaflet included in the pack.

You should only wear one patch at a time, unless told otherwise by your doctor.

You should keep the area the patch is stuck to away from any source of heat, such as a hot water bottle, electric blanket or heat pads, or sunlight. This is because heat can cause too much of the drug to be released into the blood stream too quickly.

You should inform any healthcare professional treating you that you are using opioid patches, as they can interact with other drugs.

Risks and side effects

Opioid painkillers commonly cause more side effects than other pain treatments and they need to be strictly monitored by your doctor.

Risks and side effects of opioid painkillers include:

• feeling or being sick
• problems going to the toilet
• itching
• drowsiness and dizziness
• not being able to concentrate
• low sex drive, reduced fertility, and erectile dysfunction
• more difficulty fighting off infections
• increased pain
• breathing problems.

Some side effects will lessen over the course of treatment. If you are concerned speak to your doctor.

If you have breathing problems, such as sleep apnoea, asthma, or chronic obstructive pulmonary disease (COPD), speak to your doctor before taking opioid painkillers.

Taking opioids with sedative drugs, such as diazepam, temazepam, or alcohol, can make you more likely to feel drowsy, dizzy, and unable to concentrate.

Opioid drugs can cause seizures. If you are taking antipsychotic or antidepressant drugs you could be more likely to experience seizures if you are prescribed the opioid drug tapentadol.

Opioid painkillers can become addictive and should be used with caution. Speak to your doctor if you feel they aren’t working at the prescribed dose, or you are still in pain after finishing a course of opioid painkillers.

Your doctor may recommend you stop taking opioids. Depending on how long you have been taking them you may experience some reactions, including:

• tremors or muscle spasms
• anxiety, sweating, or restlessness
• sickness, diarrhoea, or stomach cramps.

If you have been taking opioid painkillers for a long period of time you should only stop taking them under the guidance of a healthcare professional, as suddenly stopping your treatment can be dangerous.