Effects of Opioid Use for Chronic Pain
The role of long term use of opioids for chronic pain has changed dramatically over the last 10-15 years. New evidence and science continues to highlight the risks associated with chronic opioid use. With our current understanding and clinical experience the pendulum has swung from liberal use of opioids for chronic pain to now a more conservative approach
Poor Pain Relief
Opioids will not eliminate your pain. Research says that the maximum amount of pain relief from opioids may only be up 30 percent. Think about it, when you miss a dose of opioids are you having worse pain control or symptoms of withdrawal (anxiety, abdominal pain, nausea seating). If you are finding that opioids are providing no to very little pain relief and/or are not improving your function speak with your primary care provider.
- Talk to your health care provider about ways to manage your pain that does not involve prescription opioids.
- Some of these options may actually work better and have fewer risks and side effects.
- Options that may help include:
- Physical therapy and exercise
- Cognitive behavioral therapy, mindfulness based stress reduction
- Anti-inflammatories (ibuprofen, and naproxen )
- Medications used for depression or seizures may also be helpful for nerve pain
You may also benefit from referral and treatment at a multidisciplinary pain centre such as TAPMI. To find out if you are eligible and to initiate a referral please click here
Medical Complications & Side Effects
If you are experiencing side effects or complications from your opioids, speak to your healthcare provider as opioids no longer may be safe for you.
The use of prescription opioids can have a number of side effects. Some may go away in time while others may develop after long-term use.
Speak to your family doctor or nurse practitioner if you are experiencing any of the following side effects.
- Constipation, nausea and/or vomiting, dry mouth
- Sleepiness, dizziness and confusion
- Itching and sweating
- Medical complications:
- Low levels of testosterone (lower sex drive, energy, strength and affects on fertility)
- Increased fracture risks
- Increased sensitivity to pain
- Sleep apnea
- Lower mood
- Lower immunity
- Reduced urge to breathe (respiratory depression)
These risks can be minimized by working together with your healthcare team and by being honest with your medication experiences. Together you can develop a plan that ensures that your opioids are safe for you.
Reducing the Harms from Opioids
Here is what you need to know to keep you and your family safe when using opioids:
- Never take opioids in greater amounts than prescribed.
- Follow up with your primary care provider and work with them to create a plan to safely manage your opioids.
- Share any and all concerns and side effects with your health care team.
- Help prevent misuse and abuse by not selling or sharing your prescription opioids.
- Store prescription opioids in a secure place and out of reach of others.
- Safely dispose of unused prescription opioids by bringing them to your community pharmacy.
- Do not drive when your ability is impaired by opioids, it is a crime in Canada.*
* Ontario has zero tolerance for drivers of commercial vehicles. (classes A to F) . They must not have any presence of opioids in their system when driving a commercial vehicle, or they will face serious penalties, including licence suspensions and administrative monetary penalties.
If you are finding it hard to control urges or compulsions to take your opioids or you cannot stop taking the opioids despite causing harm, speak to your healthcare provider as opioids no longer may be safe for you.
The use of prescription opioids for other than their intended medical purpose is considered misuse or addiction.
- There are many treatments to manage and treat an opioid addiction. You do not need to struggle alone. Its important to ask a trusted healthcare provider for treatment options and to seek the support of your friends and family.
Reducing your opioid dose in a safe manner. To learn more about tapering click here.
Structured Opioid Use
Talk to your physician and pharmacist about ways that opioids can be prescribed, monitored and used more safety and will support you in taking opioids the way that they are prescribed
Some programs offer a monitored setting where you will stop taking your opioids. Withdrawal symptoms supported and minimized. These services may be available as an inpatient stay for several days or a day/evening program
Opioid Replacement Therapy
The opioids that you are taking are replaced with safer and longer acting opioids such as methadone or Suboxone (buprenorphine and naloxone) which may result in less cravings. These therapies work best when combined with counselling and social and community supports
You should be aware of the factors that can increase your risk for an opioid overdose:
- Altering the route of delivery (e.g., crushing, smoking or snorting pills, or injecting)
- Taking opioids not prescribed to you
- Resuming the use of an opioid after a period of not consuming opioids
- Taking more opioids than prescribed
- Switching to a stronger opioid
- Mixing opioids with street drugs and/or alcohol and/ or other sedating medications
- Having a medical condition that affects the health of your liver, kidney, or ability to breath normally
Opioid Overdose Prevention
Overdose is a medical emergency which can cause sudden death because breathing stops. Seek help immediately!
- Call 911 right away
- Follow their instructions
- Stay with the person until help arrives
Signs that someone has overdosed on an opioid:
- Slurred speech
- Very slowed, shallow breathing
- Lips or fingertips may turn blue or purple
- If asleep there may be loud snoring or unusual gurgling sounds
- Difficult to wake from sleep or don’t respond to pain (e.g. pinching)
- They are in and out of sleep — “nodding off”
Please click to learn about Naloxone. It’s free, easy to use and could mean the difference between life and death.