Fact Sheet for Patients Taking Codeine or Dihydrocodeine Containing Pain Killers

Using Opioid Medications

Although opioid pain medication might reduce your pain and improve your quality of life, it is unlikely that it will provide complete relief.

It is important you realise that this treatment involves potential risks as well as benefits. Therefore, we encourage you to understand and follow the guidance in this fact sheet. We recommend that you inform your usual medical care provider, if you are being prescribed opioid medication, in order that they can fully assess your needs and ensure that they do not give you another medicine that may interact with it.

Aims of Treatment and Anticipated Benefits

The aim of treatment is to reduce pain and improve your day-to-day functioning. Different people respond differently to opioid medications and these types of medicines are best suited for treating pain that is unlikely to last for more than 3 to 6 months in duration (acute pain). In cases where opioids are used to treat chronic pain (pain lasting for more than 3 to 6 months), there is a typical reduction of 30% of pain from baseline levels.

In high doses, there is a risk that opioid medication may make pain worse; this is important to understand in the context of pain ‘flares’ which should not normally be treated by increasing the dose of medication.

The doctor who prescribes the opioid is responsible for ensuring that you are taking it appropriately and may ask further questions to clarify your pain level, type of pain, or pain ‘score’ to determine the benefit of the medication. It is helpful to keep a record of your ability to perform activities such as how far you can walk, how long you can sit, whether you are able to perform housework or personal care, the impact of the pain on your occupation, and the effect of pain on your ability to sleep.

Side Effects of Opioid Medication

Opioids have some side effects that may be unpleasant. These side effects may increase the risk of serious health problems.

Side effects tend to vary from person to person and you may need to adjust your dose to find an optimal balance between benefits and side effects.

It is normal to develop physical dependence to opioids. Dependence means that your body has adapted to the medication and you will experience tolerance (i.e. you need to take more of the medication to achieve the same effect) and withdrawal (i.e. you may experience symptoms when you stop the medication or reduce the dose). Withdrawal from opioids is temporary and usually not dangerous, although it may be unpleasant. On average, it will take 7 days for the effects of opioid withdrawal to subside.

Common Side Effects

Withdrawal Symptoms

Risk of Serious Harm or Death

It not taken properly, opioid medications can cause serious harm or, in very rare cases, death. Higher doses are more likely to cause side effects and can include indirect adverse effects, e.g. risk of falling and therefore increased risk of injury/fracture. Overdoses of opioids, whether intentional or accidental can cause death.

Using more opioids than the recommended prescribed amount can cause sedation, slowing or stopping of breathing, or overdose. The risk is increased if the opioid medication is taken alongside alcohol, recreational substances or similar drugs, e.g. diazepam or some forms of medicines for mental illness. That is why it is absolutely essential that you tell the pharmacist or doctor about all of the other medicines, both prescribed and not prescribed that you are taking as well as any other substances both legal and illegal. This information will be treated with total confidentiality and will only be used to ensure that you are safe.

Alternatives to Opioids for Non-Cancer Pain

Your doctor may advise that you try alternative methods of pain relief, e.g. exercise, psychological therapy, physical treatments (e.g. acupuncture, massage, cold or heat packs, or manipulation therapy/physiotherapy), or other non-opioid pain medications. If you wish to consider these other options, please contact us to ask for advice.

We recommend, if possible, that you try to reduce the dose of your opioid (or even stop taking it all together) for one or two days. If you are still experiencing pain then try using an alternative for those days such as a NSAID (ibuprofen, naproxen or diclofenac) plus paracetamol. If you do manage to do this, please make a note of what happened so that you can share the information with our clinical team.

Driving1

The law in the UK allows you to drive if you are taking prescribed opioid medicines in accordance with the instructions from your prescriber (including what your prescriber advises you about driving safely). You should never drive if you feel unsafe. Your ability to drive may be affected by your pain and other medicines you are taking in addition to opioids. Opioid medicines can also make you feel tired and this will also have an impact on your ability to drive safely. You are responsible for making sure you are safe on each occasion that you drive.

The law on drugs and driving in the UK changed in 2015. If your driving is impaired for any reason, including taking medicines, it is illegal to drive. It is also now illegal to drive when you are taking opioid medicines without them being prescribed, even if you are not impaired.

It is unsafe to drive in the first few days after starting an opioid and for a few days after dose change (up or down). Drinking alcohol reduces the amount of opioid medicine you can take and drive safely so do not drive if you have drunk alcohol and taken opioid medicines.

Risk of Addiction1

It is rare for people taking opioids for pain relief to become addicted.

People who are addicted to opioids can:

It is not known exactly how many people get addicted when they are taking opioids for pain relief but it is very uncommon. It is more common if you have been addicted to opioids (including heroin) or to other drugs (or alcohol) before. Addiction may be more common in people with severe depression or anxiety. This does not mean that if you have had an addiction problem before or you are very depressed and anxious you will become addicted. It only means that you are more likely to become addicted than someone who has not had these problems. Most people do not become addicted.

So, if you have had a problem with drug or alcohol addiction in the past this doesn’t mean that you cannot take opioid medicines for your pain. However, your healthcare team will need to know about your past or current drug-taking to prescribe opioids safely and to help you watch out for warning signs.

Contact

If you have any questions, please call us on 01252 299044 or email dispensary@whitepharmacy.co.uk

Reference:

1. http://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-aware