This is a controversial subject. While opiates were prescribed frequently for chronic non-cancer pain some years ago, recent evidence showing that prolonged use of opiates can actually increase pain and cause other problems cause concern for patients and medical professionals alike.
The Hunter Integrated Pain Service (HIPS) provides some good information about managing pain and has a fact sheet on opioids.
"Across the developed world it has been common practice to maintain patients with chronic non-cancer pain on long term opioids despite lack of supporting evidence. In part this was a consequence of overly optimistic or conflicted extrapolation of evidence from acute pain management or palliative care. The chronic pain evidence base has become clearer in recent years and a change in therapeutic direction is now required".
Firstly it is important to understand that there are harmful effects of opiates. HIPS says that there is growing evidence of harm from long term opioid use. Harmful side-effects can include:
- organ problems
- cognitive impairment
- increased risk of death
- sleep apnoea
- sexual and other hormone problems
- hypothalamic-pituitary dysfunction
- Immune system suppression
- increased pain
- driving impairmen
- central nervous system sensitisation
What to do if you have been prescribed opiates over a long period of time. Suggested approach:
- Ask yourself if you managing your pain effectively. If yes, make sure you have your pain specialist test for general health. Check the harm list above to make sure you are not experiencing any of these harmful effects.
- If you decide you want to come off your opiates you are probably going to need to be under the care of a trusted pain specialist. More info about building your health care team here.
- Learn as much as you can about other ways to manage your pain.
- HIPS has a good set of resources to guide this process. http://www.hnehealth.nsw.gov.au/Pain/Pages/Community-resources.aspx
- This all will take time. Having a great team is going to be really crucial in this process. Talk to others who have gone through the process and come out the other end.
This video describes how people can come off their opiates