Opioids and how to reduce them

Opioids are the most common medicine prescribed to alleviate pain, however experts have become increasingly aware that they may not be beneficial for long-term chronic non-cancer pain [5, 6]. Opioids are a group of analgesic drugs with pain relieving qualities that can be beneficial for some types of pain, for some patients, when used in the short to medium term [7].

The Faculty of Pain Medicine advises that any medicine, including opioids, prescribed for chronic pain should not be used in isolation. Rather, they should be issued in combination with other treatment methods to support physical, psychological and social functioning [7]. On their own therefore, opioids are likely to be less effective as they do not target the psychosocial aspects of chronic pain.

There are many different forms (e.g., tablet, liquid, patch) and strengths (strong, weak) of opioid medications. To enable patients and clinicians to compare opioids, the amount of morphine in a particular preparation of opioid medication is usually calculated; this is called the Morphine Equivalent Dose (MED). The type of opioid you take, and the dosing instructions will determine your individual daily MED. Additionally, if you are prescribed and take more than one opioid, this will increase your total daily amount of morphine.

5. NICE, Chronic pain in over 16s: assessment and management. Draft for Consultation. 2020, National Institute for Health and Care Excellence.
6. Chou, R., et al., The Effectiveness and Risks of Long-Term Opioid Therapy for Chronic Pain: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop. Annals of Internal Medicine, 2015. 162(4): p. 276-+.
7. FPM. Opioids Aware. Faculty of Pain Medicine 2015  [cited Accessed: 01/02/21 01/02/21]; Available from: https://www.fpm.ac.uk/opioids-aware.

Find out more information about opioids and why you might want to consider reducing them

Faq Items

My Live Well With Pain

The My Live Well With Pain website is an excellent resource providing a range of information about pain and how to manage it. Their dedicated section on using painkillers identifies some questions to establish if opioids are right for you. The opioid thermometer is also a useful tool to help identify what your total daily MED might be depending on the opioid/s you take.

Pain concern

Pain concern have developed an informative leaflet about opioids, it may be useful to read this prior to taking opioids as it helps explain what they are, how they are used and what to expect (e.g., side effects) whilst using them. It would also be useful for patients who already use opioids and have unanswered questions about their use. Click on the following link to listen to a podcast on Opioids and Chronic Pain.

Opioids aware

Opioids aware is an information resource developed by pain experts at the Faculty of Pain Medicine and provides reliable and up-to-date information about using opioids for chronic pain. The information is useful for both health care professionals and patients, with a dedicated section for patients providing downloadable information on a range of different opioid drugs and other pain interventions. 

Pain tool kit

The pain tool kit provides a great summary of key points on pain medication, including information on weak and strong opioids. Additionally, the following animated

from Dr Mike Evans provides an easy-to-understand overview of the best advice for people on or about to start opioid medication.

Why should you consider reducing opioids?

There are many reasons why you might consider reducing your opioid medication. For example, healthcare professionals advise that if opioids are used as a long-term treatment, patients often develop tolerance, dependence and an increased sensitivity to pain (opioid-induced hyperalgesia), which can lead to reductions in the pain relieving qualities of opioid medication [8]. This would explain why a reduction in pain is not often felt, even when the dose or strength of your opioid medication is increased. Another reason might be that opioids simply are not effective for the type of pain you have [9].

There is also strong evidence that at higher doses (particularly above 120mg morphine equivalent a day) opioids increase the risk of serious harm such as falls, fractures, accidental overdose, heart attack and even increases in pain [6, 10-12]. This is why UK healthcare experts including the Faculty of Pain Medicine, and the National Institute for Health and Care Excellence (NICE) recommend that CNCP patients using opioids above 120mg morphine equivalent dose per day should reduce their dose. Click on this link

to watch a short two-minute video explaining the risks and limited effectiveness of taking opioids.

6. Chou, R., et al., The Effectiveness and Risks of Long-Term Opioid Therapy for Chronic Pain: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop. Annals of Internal Medicine, 2015. 162(4): p. 276-+.
8. Ballantyne, J.C., The brain on opioids. Pain, 2018. 159(S24-S30).
9. Bialas, P., et al., Efficacy and harms of long‐term opioid therapy in chronic non‐cancer pain: Systematic review and meta‐analysis of open‐label extension trials with a study duration≥ 26 weeks. European Journal of Pain, 2020. 24(2): p. 265-278.
10. Els, C., et al., Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews, 2017(10).
11. Dunn, K.M., et al., Overdose and prescribed opioids: Associations among chronic non-cancer pain patients. Ann Intern Med, 2010. 152(2): p. 85-92.
12. Bedson, J., et al., Risk of adverse events in patients prescribed long-term opioids: A cohort study in the UK Clinical Practice Research Datalink. European Journal of Pain, 2019. 23(5): p. 908-922.

You may also find additional useful information on the websites listed below:

Opioids aware

Opioids aware has information on stopping opioids that is tailored for healthcare professionals, but it may be useful for patients as it provides a perspective on what to expect and how a reduction is managed. Opioids aware recommend that opioid reduction should be considered:

  1. When opioids no longer provide effective pain relief, particularly in doses above 120mg morphine equivalent a day.
  2. If the underlying condition resolves.
  3. If another pain intervention is given to eliminate the pain.
  4. If there are intolerable side effects, and
  5. If there is evidence of diverting medication.

My live well with pain

My live well with pain – has an information leaflet on reducing opioids explaining how reduction is done and some general information about opioids and their potential harms. A separate but related website (Live Well with Pain) designed for healthcare professionals, also provides information for patients who are thinking about reducing their opioids, explaining opioid side effects, what to expect during opioid reduction and how tapering down from high doses is managed. You can also access videos of patients sharing their personal experiences of life after opioids.

Living well with pain

Living well with pain, developed by someone living with chronic pain, shares information about the authors’ experience of using opioids and the need for medication reviews. On here you can find video clips showing lived experiences of using and reducing opioids as well as links to pain education videos.

Pain concern

Pain Concern provide a leaflet on opioids with brief information on stopping. There is also a 30min podcast on opioids and chronic pain where experts and a patient talk about the impact of opioids on quality of life.

Health talk

Health talk is a resource sharing experiences of people living with a range of long-term health conditions, including chronic pain. On this site, people share their experience of using opioids, dealing with the side effects, risk of addiction, the importance of medication reviews and issues around reducing and stopping opioids.