WHO TO CONTACT FOR ADVICE
During normal surgery hours
• Your Pharmacist
• Your GP
• Your Clinical Nurse Specialist
Outside usual surgery hours
• The out of hours GP service or telephone 111
• Your District Nurse
• Specialist palliative care advice is available 24/7 in worcestershire
PATIENT RELATIONS TEAM
It is important that you speak to the department you have been
referred to if you have any questions (for example, about medication)
before your investigation or procedure.
However, if you are unhappy about the service you have received and
would like to talk about it or make a formal complaint, please contact
the Patient Relations Team who provide a confidential service and can
support you to make a complaint or raise a question, or concern about
your care and treatment. They can be contacted either in writing
to the Patient Relations Team, Worcestershire Health and Care NHS
Trust, Isaac Maddox House, Shrub Hill Road, Worcester, WR4 9RW, by
telephone: 01905 681517 or via Email: [email protected]. On receipt
of your complaint, an investigation will be undertaken and the Chief
Executive will then write to you with outcome and findings from the
investigation.
Patient information leaflet
Opioids in Palliative Care
If you would like this information in other formats or languages
please contact the team who supplied you with this leaflet.
www.hacw.nhs.uk
There are many different types and strengths of painkillers suitable
for different types of pain. Usually, the first step to manage pain is to
try a simple painkiller like paracetamol. If this is not effective then the
next step is generally a moderately strong painkiller like co-codamol
or tramadol. If your pain is still not well controlled then your doctor
will usually prescribe a strong painkiller. The strongest painkillers
used for controlling cancer pain or pain associated with progressive
disease are called strong opioids.
This booklet has been given to you because you are either being
started on or are already taking a medicine known as a strong opioid.
The healthcare professional who provides you with this booklet will
explain the information contained in it.
OPIOIDS
Opioid medicines are commonly used to relieve pain and can also be
used to relieve breathlessness or cough.
Common examples of strong opioids are: Buprenorphine,
Diamorphine, Fentanyl, Morphine, Oxycodone.
These opioids come as different brands and not all brands are
the same. Therefore, once you have started on one brand it is
recommended that you stick to that brand. If you notice that the
opioid medicine you have been given looks different in any way
to what you have previously received please discuss this with your
pharmacist.
HOW TO TAKE OPIOIDS
You will usually be prescribed a regular opioid for which the frequency
will differ depending on what you are prescribed, e.g. every 12 hours
for modified-release tablets / capsules. This is used to treat pain you
have all the time which is called ‘background pain’.
Name of medication ____________________________
When to take __________________________________
For people who are travelling for more than 3 months, a licence from
the Home Office is required. Your doctor needs to fill in this form and
send it to the Home Office.
To get a licence you can:
• Contact the Home Office Drugs Licencing and Compliance Unit by
telephoning 02070356330
• Use this website to download a form: www.homeoffice.gov.uk/
drugs/licencing
Note: it can take up to 2 weeks for this form to be processed by the
Home Office. It is best to allow plenty of time to apply for this licence.
FURTHER INFORMATION
Please also refer to the manufacturers patient information leaflet for
further information in relation to the specific strong opioid prescribed
(e.g. missed doses etc).
“Facts about painkilling drugs” are available from Macmillan Cancer
Support at: www.macmillan.org.uk/information-and-support/coping/
side-effects-and-symptoms/pain/painkillers-and-how-they-are-taken.
html
If your pain improves and you no longer require them then you
may be able to stop them but this should only be done under the
supervision of a healthcare professional.
WHEN TO SEEK MEDICAL ADVICE
If you need advice or have problems out of normal hours contact your
out of hours GP or district nurse.
• If your pain gets worse and is not controlled by your current
medication
ADDICTION
• If you become more drowsy or sleepy than usual
Many people are frightened that they will become addicted to their
strong painkillers. This is extremely unlikely to happen whilst you are
taking the medication for pain.
• If you are being sick for more than 24 hours
SIDE EFFECTS
• If you experience hallucinations or bad dreams
Drowsiness
Seek medical advice if you experience one or more of the following;
• If you feel confused or not quite yourself
• If you feel restless
This should improve after a few days of taking these drugs or after a
dose increase. Until this has settled down it is advisable not to drink
alcohol and to avoid driving or operating machinery.
Sickness
Some patients may experience nausea (and rarely vomiting) when they
first start a strong opioid. This should also improve by itself after a few
days but if it is a problem your doctor will be able to prescribe you
some anti-sickness medication.
Constipation
This affects most people taking strong painkillers and the doctor will
usually prescribe a laxative for you to take to prevent constipation
becoming a problem. It is important to drink plenty of fluids and take
any laxatives regularly that are prescribed to you by your doctor.
Other Side Effects
STORAGE
Other less common side effects include itching, heartburn, change in
taste of some foods and difficulty in passing urine. If you experience
any of these side effects please tell your healthcare professional.
Store your medicines in a cool, dry, safe place out of the reach of
children.
DRIVING
Strong opioids can affect your ability to drive as it may make you
sleepy or dizzy.
However, you may experience pain before your next dose of regular
opioid is due. This is known as ‘breakthrough pain’. The duration and
cause of this pain will differ from person to person. You will also be
prescribed a faster acting medicine for ‘breakthrough pain’. This is for
when your pain suddenly gets worse and you need something extra.
• Do not drive whilst taking strong opioids until you know how they
affect you.
Name of medication ____________________________
• It is an offence to drive if strong opioids affect your ability to drive.
When to take __________________________________
However, you would not be committing an offence if:
If you experience pain before your next dose of regular opioid is due
then you should take an additional dose of fast acting opioid that you
have been prescribed. An example of a fast acting opioid is Oramorph.
If you find you are having to take a lot of additional doses, let your
healthcare professional know.
• strong opioids had been prescribed to treat a medical or dental
problems and
• you have taken them according to the instructions given by the
prescriber or in the information provided with the medicine and
• they are not affecting your ability to drive safely.
Talk to your doctor or pharmacist if you are not sure whether it is safe
for you to drive while taking strong opioids.
For further information go to https://www.gov.uk/drug-safety-update/
drugs-and-driving-blood-concentration-limits-to-be-set-for-certaincontrolled-drugs-in-a-new-legal-offence. Information leaflet to give to
patients
TRAVELLING ABROAD
If you need to travel abroad with a strong opioid, you will need to
check first with the Embassy or High Commission (of the country you
are visiting) to see if they will allow you to take these medicines with
you. If these medicines are allowed, you will need a letter from your
doctor which states your name, address, date of birth, the dates of
travel in and out of the country and the country you are visiting. The
letter will also need to list the medicines you’re taking, doses and the
total amounts you’re taking with you.
MONITORING AND PRESCRIPTIONS
It is helpful to make a note of the amount of ‘breakthrough’ doses
you are having to take as it helps your doctor or nurse to adjust your
pain medication more accurately. Often patients write these down in a
notebook or diary which they can then show to their doctor or nurse.
Prescriptions
Your GP or your hospital doctor will provide you with prescriptions
for your opioid medication. Strong opioids are controlled drugs for
which there are certain regulations with regards to their dispensing.
These prescriptions are only valid for 28 days after the date on the
prescription and only up to 30 days supply can be prescribed and
issued to you.
It is very important that you never run out of your medication
and ensure that you get your next prescription to your community
pharmacy a few days in advance to ensure they have adequate supply
in stock. When you or a representative collect your medication a
signature and identification may be requested.
You should not stop taking these drugs unless you are advised to by a
doctor or specialist nurse as this is likely to make you feel unwell for a
few days afterwards. This is called a withdrawal reaction.