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

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

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.