Use of opioid medications for chronic pain

It is important to understand the difference between opioid medications prescribed by a doctor and opioids available as “street drugs.”

The opioid medications prescribed by a doctor are needed to relieve some people’s chronic pain. Their use is supervised by a health professional and is regularly and strictly monitored.

Opioid medications are used by some people and in some circumstances to relieve moderate to severe chronic pain. They act on the brain to control pain. When used as prescribed by the doctor and as advised by a pharmacist, they have beneficial effects on the quality of life of people with chronic pain.

There are different types of opioid medications, including:

• Morphine
• Codeine
• Hydromorphone
• Oxycodone
• Hydrocodone
• Tramadol
• Tapentadol
• Fentanyl
• Buprenorphine
• Methadone

The treatment duration, dose and frequency with which to take this medication vary from person to person. Your doctor will determine the best treatment for you.

It is vital to strictly follow your doctor’s or pharmacist’s recommendations. Misuse of opioids carries significant health risks.

Storing opioid medications

Keep your opioid medications in their original packaging. Store them safely, ideally in a place under lock and key, out of the reach and sight of children and pets.

Sharing medications

Never share your opioid medications with other people. They could be dangerous for them.

Following health professionals’ instructions

Always follow your doctor’s instructions regarding the prescribed doses and dosing intervals (timing). In addition, never change the form of the medication (for example, do not crush any pills).

Missing a dose

If you forget to take a dose of your opioid medication, do not take a double dose to make up for the one you missed. Talk with your pharmacist or call Info-Santé 811 to find out what to do in this case.

Pregnancy and breastfeeding

If you are pregnant, trying to get pregnant or breastfeeding, discuss this with your doctor.

Opioid medications may cause undesirable effects. These generally lessen over time.

if the undesirable effects of your medications bother you too much and prevent you from functioning normally, talk with your doctor or pharmacist. They may change your medication or dosage so that you no longer experience these undesirable effects. They can also help you manage them.

The earliest and most common undesirable effects include:

• Nausea, vomiting
• Constipation
• Dry mouth
• Sweating
• Drowsiness (urge to sleep)
• Dizziness
• Mental confusion
• Itchiness

Other undesirable effects may appear if you take opioid medications for a long time.

• Hormonal problems (hypogonadism)
  Hypogonadism is a decrease in sex hormones. Several symptoms are associated with it, such as fatigue or low sex drive.
• Sensory hypersensitivity (hyperalgesia)
  Your body over-reacts to sensations that should not be painful. You may feel aches and pains all over your body.
• Sleep apnea and respiratory depression
  Opioid medications may decrease your breathing rate and rhythm. They may also cause your breathing to stop and restart during sleep (sleep apnea).

If you have been taking opioid medications for a long time and feel that you are experiencing some of these undesirable effects, talk with your doctor.

Prolonged use of opioid medications may lead to the development of tolerance and physical or psychological dependence.

Some people may develop opioid tolerance, which means that they need a higher dose to obtain the same analgesic effect (pain relief). If this applies to you, talk with your healthcare team.

Your body gets used to a certain daily dose of opioids. Abruptly stopping or decreasing an opioid dose can lead to unpleasant withdrawal symptoms. This is physical dependence. This does not mean that you are addicted or misusing your medications. If you decide to stop taking opioid medications, you are advised to talk with your healthcare team. A gradual dose reduction is recommended.

Misuse and psychological dependence occur when patients behave in one or more of the following ways:

• They are not taking their medications for the prescribed purpose.
• They are not following the prescribed dosage regimen, that is, the amount of medication they must take and the interval between each dose (timing).
• They are no longer adequately controlling their medication intake.

If you feel that you are no longer taking your medications for the purpose they were prescribed to you or that you are no longer able to follow your dosage regimen, talk with your doctor or pharmacist.

An overdose occurs when someone takes a greater amount of opioids than their body can handle. Opioid overdoses are a real risk associated with taking opioid medications. Overdoses do not happen only to people with opioid use disorder. To prevent an overdose, you must take your doses as prescribed and follow the rules for the safe use of opioid medications as instructed by your doctor.

It is very important for your loved ones to be able to recognize the signs of an overdose and to know what to do in case of an overdose.

While opioid medications may be effective for pain management, other non-pharmacological methods can also help you.

Physiotherapy, psychotherapy, acupuncture, massage, heat or cold therapy, support groups, relaxation activities, such as yoga and mindfulness meditation, physical activity and leisure activities are all methods than can help improve your pain management.

The website My pain management  provides plenty of information on this topic.

It is important to talk with your doctor or pharmacist before discontinuing an opioid medication.

Stopping opioid medications can lead to withdrawal symptoms. You and your doctor can draw up a plan for you to stop taking opioid medications. Tapering off your doses (gradually reducing them) can help you have fewer withdrawal symptoms. Your doctor can also suggest non-pharmacological treatments or, if necessary, prescribe non-opioid medications to ease your withdrawal symptoms. Your pharmacist can also assist you with this process.

Withdrawal symptoms include nausea, cold sweats, shivering, headache, fatigue, stress, vomiting, sleep problems, diarrhea, stomach ache, and a runny nose. You may also experience an increase in your original pain in addition to muscle aches and joint pain. These symptoms start within 6 to 36 hours of your last opioid dose. They lessen within 3 to 7 days and then disappear.

If you stop taking this medication abruptly, these symptoms could be even more severe and could last longer. They are rarely fatal.

Unused medications

For information on this topic, see the page Safe disposal of expired or unused medication.

Info-Santé 811: a telephone hotline to chat with a nurse. This service is free and confidential.

911: number to call in case of emergency, such as an overdose.

Drugs  or 1-800-265-2626: an assistance and referral service. If your opioid use or that of a loved one is worrying you.

My pain management : educational resources for patients, family caregivers and health professionals.

Quebec Chronic Pain Association  (in French only): information, support and tools for people with chronic pain, along with public awareness and outreach.

1-855-DOULEUR or 1-855-368-5387: help line for people dealing with chronic pain.