What are opioids?

Opioids are a group of medicines that may be prescribed by doctors to treat pain. Opioids reduce feelings of pain by interrupting the way nerves signal pain between the brain and the body. Sometimes opioids are taken after being obtained illegally for non-prescribed use.

Opioids work by interacting with the opioid receptors in your brain. This results in a range of effects, including altering how you feel pain. Opioid-based medicines may be prescribed by your doctor, and contain regulated active ingredients such as:

• codeine
• fentanyl
• morphine
• oxycodone
• pethidine
• tramadol

These medicines can be taken in different ways, including as tablets or pills, injections or patches on the skin.

What are the benefits of opioids?

Your doctor might prescribe opioids for these reasons:

• treatment of acute pain such as pain associated with surgery or a medical procedure
• treatment of chronic pain (pain lasting more than 3 months) caused by cancer
• reducing pain in palliative or end-of-life care
• substitution therapy to reduce harm for people who are opioid-dependent

Opioids are not very effective in treating chronic pain that is not caused by cancer.

How are opioid medicines obtained?

Before you take opioid medicines, you need to have a prescription from your doctor. You cannot buy opioids over the counter from a pharmacy. For acute pain, your doctor is likely to prescribe enough medication for the expected duration of severe pain.

For chronic pain, your doctor may recommend you trial an opioid for a short period and monitor for improvement over time.

What are the risks in using opioids?

Like all medicines, opioids are associated with several possible risks. Some unwanted effects of opioids may be mild, such as drowsiness, nausea, and constipation. Others can be serious and may be signs of an overdose.

These signs include shallow breathing and being unresponsive or unconscious. You can reduce these risks by taking your opioid only as prescribed by your doctor.

Speak to your doctor or pharmacist before taking your opioid with other medications (prescribed or non-prescribed) and don’t take opioids with alcohol. Never share your opioids with anyone.

How can I avoid becoming addicted to opioids?

Opioids are generally not prescribed for long-term use (except in the management of some cancer pain). This is because the longer you take opioids, and the higher the dose, the more likely you are to experience harmful effects.

Long term use of opioids can put you at risk of being dependent on opioids, which is why regular review with your doctor is important.

Your doctor may reduce your dose of opioids over time, and introduce other pain management strategies, such as exercise and counselling services, or other medicines like paracetamol. These have been found to help many people manage their pain, while minimising the risks associated with opioid use.

When should I see my doctor?

When trialling an opioid, see your doctor every 1 to 2 weeks to monitor your progress and discuss any concerns.

If you are concerned that you or someone you know may have taken too much of a prescribed opioid, call your doctor or the Poisons Information Centre (13 11 26) immediately for advice.

If you are concerned about addiction to opioids, make an appointment to see your doctor. Your doctor may slowly decrease the amount of opioid you are taking or enrol you in an opiate substitution treatment program, involving addiction treatments such as methadone or buprenorphine.

How do I know if someone is having an opioid overdose?

You may see the following signs in a person having an opioid overdose:

• quick onset of slow, difficult or shallow breathing
• vomiting
• gurgling or choking sound
• bluish skin and nails
• slow breathing
• being unresponsive

These signs of overdose are the same whether the opioid was a prescribed medicine or it was obtained and/or used illegally.

Naloxone is a medicine that can reverse the effects of an opioid overdose. The Take Home Naloxone pilot program, funded by the Australian government, offers certain individuals in NSW, SA and WA this medication for free and without a prescription between 1 December 2019 and 28 February 2021. Speak with your doctor or pharmacist if you would like information about this initiative.

What should I do in cases of overdose?

For urgent medical attention, call triple zero (000) or go to the emergency department of your nearest hospital.

If someone overdoses on opioids, naloxone should be given urgently.

Understanding naloxone

Naloxone treats opioid overdose by temporarily blocking opioid receptors and in this way blocks the opioid drugs from working. Naloxone doesn’t make people feel ‘high’, doesn’t itself cause addiction and there have been no reported deaths from naloxone overdose.

Naloxone stays in the body for a shorter time than many opioid drugs. While naloxone works for around 1 to 1.5 hours, heroin and other opioid drugs stay in the body for much longer (more than 12 hours for some sustained-release opioids). It’s common for people who have been revived with naloxone to crave more opioid. It is important to remember that taking more opioids after taking naloxone could cause a second overdose and is particularly dangerous.

Naloxone is injected into a muscle or given as an intranasal spray. In the event of an emergency opioid overdose, naloxone can be administered by family, friends, or bystanders. Note the dose and the time the naloxone is given so you can tell emergency medical professionals, such as paramedics, when they arrive to assist.

Resources and support

For more information on opioid use and overdose prevention:

• Talk to your doctor or pharmacist.
• Learn more about the Take Home Naloxone pilot.
• Contact the Pharmacy Programs Administrator to find out how to register for the Take Home Naloxone pilot on 1800 951 285 (9am to 8pm AEST, Monday to Friday).
• For overdose resources, including step-by-step videos, go to the Penington Institute website.
• For advice on medicines, including opioids and naloxone, call the NPS Medicines Line on 1300 MEDICINE (1300 633 424; 9am to 5pm AEST, Monday to Friday).