Taking opioid medicines safely

An opioid is a type of medicine your doctor may prescribe to treat your pain. Opioids work by blocking pain messages between your brain and the rest of your body. This can provide pain relief, but may also slow your heart rate and breathing. There are many different types of opioid medicines.

Some opioids, such as heroin, are illegal.

There are 2 types of opioid medicines:

• Opiates that occur naturally and come from the opium poppy — these include codeine, morphine and heroin.
• Opioids that are made in a laboratory or factory — these include pethidine and fentanyl.

What are the benefits of opioids?

Your doctor might prescribe opioids to:

• treat acute (short-term) pain, such as pain associated with surgery or a medical procedure
• treat chronic pain (pain lasting more than 3 months) caused by cancer
• reduce pain in palliative or end-of-life care
• manage addiction to other opioids — your doctor may prescribe methadone as a substitute for more harmful opioids, such as heroin

You can check if your medicine is an opioid by asking your doctor or pharmacist.

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

Research shows that opioid medicines are not very useful for managing chronic non-cancer pain (also known as persistent pain).

Learn about more effective strategies to treat chronic pain.

Common side effects with short-term use of opioids include:

• nausea, vomiting and constipation
• drowsiness, dizziness and sedation
• confusion, delirium and slurred speech
• itchy skin
• urinary retention

You may also develop some life-threatening side effects including:

• breathing problems
• slow heart rate
• low blood pressure
• loss of consciousness

You are more likely to have side effects:

• when you first start taking opioids
• after your dose is increased
• if you are older than 65 years
• if you are living with kidney disease, heart disease, lung disease, neurological disease or obesity
• if you take other medicines that have sedative effects, such as benzodiazepines

Even if you take your opioids exactly as prescribed, you may still experience side effects. The severity of side effects can also vary from person to person.

Side effects can impair your ability to drive or operate heavy machinery safely. If you experience side effects, it is important to avoid driving, as you have a higher chance of having an accident.

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

• not drinking alcohol
• avoiding benzodiazepines (Opens in new tab), 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 discuss other ways to manage your pain.

Taking opioids for a long time increases your chance of side effects, which can include:

• sleep apnoea
• heart attack and other heart problems
• neurological problems — lack of coordination, resulting in falls and injuries, sedation and delirium
• chronic constipation
• nausea and vomiting
• osteoporosis and bone fractures
• reduced immunity

Taking opioids for a long time is associated with additional risks including:

• developing tolerance to opioids
• opioid-induced hyperalgesia (increased sensitivity to pain)
• developing a dependence on opioids
• developing an addiction to opioids

Opioid tolerance

Evidence shows that the longer you take an opioid, the less pain relief you will feel. This is because your body gets used to the dose of opioid that you are taking — known as 'tolerance'. When you develop tolerance to an opioid medicine, you will need a higher dose of the medicine to feel the same effect. Higher doses also increase your chance of serious side effects.

Opioid-induced hyperalgesia

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

Physical dependence to opioids

It is also possible to become dependent on opioid medicines. This means that you may experience withdrawal symptoms after stopping the medicine, as well as cravings (feeling a strong need or desire for opioids).

Addiction to opioids

Some people can become addicted to opioids. This means that they feel a compulsion (an overwhelming or strong need) to take opioids even if the medicine is having a negative effect on their health and wellbeing. Symptoms of addiction include uncontrollable cravings and not being able to control your opioid use, despite its negative effect on your personal relationships or finances.

Naloxone reverses the effects of opioids and treats opioid overdose by temporarily blocking the effects of opioids on the brain and body. This temporarily stops opioid drugs from working. Naloxone does not make you feel 'high' and does not cause addiction.

Naloxone can be given as:

• an infusion into a vein
• an injection
• a nasal spray

If someone is suffering an opioid overdose, or a severe reaction (loss of consciousness or slowed breathing) naloxone can be given by family, friends or bystanders.

Learn how you can respond in case of an emergency (Opens in new tab) from the Opioid Safety Toolkit.

If you give naloxone, note down the dose and the time the naloxone is given. This way you can tell emergency medical professionals, such as paramedics, when they arrive.

Naloxone stays in the body for a shorter time than many opioids. Naloxone works for about an hour. Heroin and other opioids can stay in the body for much longer. If you take or give someone naloxone, be aware that the overdose can resume after the naloxone stops working.

Take Home Naloxone program

Naloxone is a medicine that can temporarily reverse the effects of an opioid overdose. The Australian Government is offering this medicine free of charge and without a prescription to people who may experience, or witness, an opioid overdose.

Read more about the Take Home Naloxone program (Opens in new tab).

Learn more about creating your own opioid safety plan (Opens in new tab) at the Opioid Safety Toolkit.

The Australian Government is working with healthcare professionals to reduce harm caused by prescription and non-prescription opioids. Doctors carefully examine why you are prescribed opioids and check if there are other treatment options to manage your pain.

The number of doses of opioid medicines prescribed 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, for example, if you have cancer or are receiving palliative care, you will still be able to receive your medicine in the same way, with the same pack sizes.

In some cases, your doctor may refer you to a pain specialist to check if your treatment is still right for you. Talk to your doctor for more information.

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

• Only use medicines that are prescribed for you. Take them exactly as your doctor prescribes.
• Avoid alcohol, benzodiazepines, cannabis and illegal drugs while taking opioid medicines.
• Learn how naloxone can be used (Opens in new tab) 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 are having 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 do not need anymore, ask your doctor or pharmacist how you can safely get rid of them.

You should see your doctor if you:

• are taking an opioid medicine and you want to make sure it is still the right treatment for you
• were prescribed an opioid and it is not helping to reduce your pain
• want to stop taking an opioid medicine safely — your doctor can discuss the safest way to do this
• are experiencing withdrawal symptoms after stopping an opioid medicine

If you are concerned about someone else who is taking opioid medicines, you may feel uncomfortable talking about it with them.

Here are some tips on what to do if you are concerned about someone's opioid use:

• 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 available options to treat pain. This may include non-medicine options.
• Find information and support services for the person affected or for yourself using the Alcohol and Drug Foundation Path2Help service. (Opens in new tab)
• Learn more about helping someone who may be misusing drugs or alcohol.

• Discuss your pain on the Pain Link helpline (Opens in new tab) (1300 340 357), which is staffed by volunteers with personal experience of chronic pain.
• Visit Painaustralia (Opens in new tab) to find pain services and programs in your area.
• Visit the Safe Opioid Use (Opens in new tab) website to learn more about using opioids safely and creating your own opioid safety plan.

Languages other than English

The Alcohol and Drug Foundation has translated their guide to using medicines safely (Opens in new tab) into many community languages.

The Pain Management Network has translated their resources (Opens in new tab) into a variety of community languages.

Information for Aboriginal and/or Torres Strait Islander peoples

Your Room (Opens in new tab) has information about drugs and resources for Aboriginal and/or Torres Strait Islander peoples.

The Pain Management Network has a collection of resources (Opens in new tab) for Aboriginal and/or Torres Strait Islander peoples.