Felicia Cox FRCN MSc RN
Nurse Consultant, Pain Management
Royal Brompton & Harefield Hospitals, Part of GSTT
Dr Jane Quinlan FRCA FFPMRCA
Consultant in Anaesthesia and Pain Management, Oxford University Hospitals Trust
Honorary Senior Clinical Lecturer, University of Oxford
Better patient education will help people use, store and reduce their opioids more safely.
Opioids such as morphine and oxycodone are strong and effective pain medicines for pain after surgery. They are best used in combination with other ways of managing pain. Opioids are not without risk, with excessive opioid prescribing on discharge from hospital contributing to the community opioid burden.
Improving patient education
The British and Irish Pain Societies have collaborated with patient and professional organisations to develop a patient information booklet which supports patients to safely manage their pain once they have left hospital.
The information covers the whole surgical pathway, describing what patients can do to before their surgery to increase fitness and to set expectations about pain and recovery afterwards. It explains how medicines – both opioid and non-opioid drugs – work to relieve pain and gives suggestions for non-drug techniques for managing pain such as using distraction and exercise. It also provides a personal pain management plan that is jointly agreed by the patient and their healthcare team to achieve their recovery goals.
Immediate opioid risks include “opioid-induced ventilatory impairment” which results from slow breathing, drowsiness and a loss of muscle tone in the airway. If left untreated this can result in death. Later opioid risks involve the continued use of opioids after the anticipated recovery period – “persistent postoperative opioid use” – which can result in dependence and addiction. The booklet guides patients to reduce and stop their opioids as the acute postoperative pain settles.
Further, where patients are prescribed more opioids than they need, there is the broader societal risk of diversion of unused opioids; or the devastating impact of accidental ingestion and overdose by children or pets if not stored out of sight and reach.
Opioids are not without risk, with excessive opioid prescribing on discharge from hospital contributing to the community opioid burden.
Raising awareness of harm
By informing patients and their carers about the risks and benefits of opioid medicine for acute postoperative pain it is hoped to reduce adverse events.
The five key safety messages are:
- Lock opioids safely away. Keep them out of reach of children.
- Reduce and stop opioids as your pain decreases.
- Take unused medicines to a pharmacy for disposal.
- Tell your carers to call 999 if they can’t wake you up or if your breathing is very slow. Ensure they tell doctors or paramedics you take opioids for pain.
- Do not drive while taking postoperative opioids.
