Asking questions is not a sign that something is wrong, or that anyone doubts your pain. It is part of taking these medicines safely, and your pharmacist is one of the best people to ask.

Key points

• • Opioids can help some people, but their benefit for long term pain often fades over time while the risks build.
  • Regular reviews with your doctor and pharmacist are a normal part of safe use.
  • Avoid combining opioids with alcohol, sleeping tablets or other medicines that cause drowsiness.
  • Naloxone, a medicine that reverses an opioid overdose, is available free and without a prescription in Australia.

Is this medicine still doing its job?

Over time, your body adapts to opioids. This is called tolerance, and it means the same dose may give less relief than it once did. Increasing the dose can bring the relief back for a while, but it also increases the risks.

For long term pain, the goal is usually not zero pain. It is being able to do more of what matters to you, like walking, working, sleeping or looking after family. A useful question for your doctor and pharmacist is: what is this medicine helping me do, and how will we know if it stops helping?

What side effects should I be watching out for?

Constipation is one of the most common side effects, and unlike some others, it rarely improves with time. Ask your pharmacist about a plan to prevent it rather than waiting until it becomes a problem. Drowsiness, dizziness and nausea are also common, especially after a dose change, and can raise the risk of falls.

With long term use, opioids have also been linked to sleep apnoea, hormone changes, heart problems and weaker bones. They can affect your ability to drive safely, particularly when starting or changing a dose. If you notice any of these, raise them at your next review.

Which other medicines are risky with opioids?

The biggest risks come from combining opioids with other things that slow breathing or cause drowsiness. These include alcohol, sleeping tablets, anxiety medicines, some nerve pain medicines, some antihistamines and cannabis.

Before starting anything new, including over the counter products, check with your pharmacist. It helps to use one pharmacy for all your medicines so someone can see the full picture. When you fill a script for an opioid, your pharmacist will also check a national monitoring system that shows your recent prescriptions. This is a routine safety step for everyone, not a judgement about you.

Should I keep naloxone at home?

If you take opioids regularly, it is worth having. Naloxone temporarily reverses the effects of an opioid overdose, which can happen by accident, for example after a dose change or when combined with alcohol. Through the Australian Government's Take Home Naloxone program, it is free and available without a prescription from participating pharmacies.

Make sure the people you live with know where it is and what an overdose looks like: being very hard to wake, slow or shallow breathing, or blue lips. Call 000 straight away if this happens, even after giving naloxone.

What if I want to reduce or stop?

Never stop an opioid suddenly. Your body will have adjusted to it, and stopping abruptly can cause withdrawal symptoms such as restlessness, sweating, stomach upset and a temporary rise in pain. Reducing slowly, with a plan agreed with your doctor, is much safer and more comfortable.

Some people find that as their dose comes down, their thinking feels clearer and their energy improves. A reduction plan works best alongside other support, such as physiotherapy, pacing and psychological strategies for pain. Keep unused opioids locked away from children and visitors, and return any you no longer need to a pharmacy for safe disposal.

How Ace can help

Ace pharmacists can review all your medicines together to spot risky combinations, help you stay ahead of side effects like constipation, supply naloxone, and support a reduction plan agreed with your doctor. Get started with Ace.

References

healthdirect. Taking opioid medicines safely.

healthdirect. Opioid medicines and pain.

healthdirect. Options for managing chronic pain.

Agency for Clinical Innovation, Pain Management Network. Chronic pain.

This article is for general information only and does not constitute medical advice. Never change or stop an opioid without speaking to your doctor. In an emergency, call 000.