Opioids and Dependence: Using Strong Painkillers Wisely

What are opioids?

Opioids are a group of strong painkillers that include medicines such as codeine, tramadol and morphine. They work by attaching to opioid receptors in the brain, spinal cord and elsewhere, dampening pain signals and altering how pain is perceived. Used appropriately, they have an important role, particularly for short-term severe pain, pain after surgery, and some cancer-related and palliative care.

However, opioids carry real risks, and awareness of these has grown considerably. They are not a first choice for most everyday or long-term pain, and they are always prescription-only medicines that need careful supervision.

When opioids are appropriate

Opioids can be valuable in specific situations, such as:

• Short-term relief of severe pain, for example after an injury or operation
• Cancer pain and palliative care
• Some cases of severe pain where other treatments have not worked, under specialist guidance

For many types of long-term, non-cancer pain, the evidence that opioids help is limited, while the risks of long-term use are significant. This is why doctors increasingly favour other approaches for chronic pain, as discussed in our guide on coping with chronic pain.

Understanding tolerance, dependence and addiction

These terms are often confused but mean different things:

• Tolerance: over time, the body may need more of the medicine to get the same effect.
• Physical dependence: the body adapts to the medicine, so stopping suddenly causes withdrawal symptoms. This can happen even when a medicine is taken exactly as prescribed.
• Addiction: a harmful pattern of compulsive use despite negative consequences, which is different from physical dependence, though the two can overlap.

Because of physical dependence, opioids should never be stopped abruptly after regular use. A doctor will usually reduce the dose gradually to avoid withdrawal effects such as restlessness, sweating, aches and low mood.

Side effects and risks

Opioids commonly cause:

• Constipation, which can be persistent
• Drowsiness and reduced concentration, affecting driving and machinery use
• Nausea, especially when starting
• In higher doses or combinations, dangerously slow breathing, which is the main cause of serious harm

The risk of serious harm rises sharply when opioids are combined with alcohol or with other sedating medicines such as some sleeping tablets or muscle relaxants. Always tell your doctor and pharmacist about everything you take.

Using opioids more safely

If you are prescribed an opioid:

• Use the lowest effective dose for the shortest necessary time
• Take it exactly as directed and never increase the dose yourself
• Avoid alcohol and check before combining with other sedating medicines
• Discuss a plan for reducing and stopping from the outset
• Keep them stored safely away from children and others
• Return any unused medicine to a pharmacy

Simpler painkillers from our pain range are often the right starting point for milder pain, and a pharmacist can advise. You can also shop all to see the wider range of options.

When to seek help

Speak to your doctor if you feel you need increasing amounts, are using opioids to cope with stress or low mood, or are worried about your use. Seek emergency help immediately if someone is very drowsy and difficult to wake, has slow or shallow breathing, or has blue lips, as these are signs of a potentially life-threatening overdose.

The bottom line

Opioids are powerful painkillers with an important but limited role, mainly for short-term severe pain and certain specialist situations. They carry real risks of tolerance, dependence and addiction, and must be used carefully under medical supervision, never stopped abruptly, and never mixed casually with alcohol or other sedatives. For most long-term pain, broader management strategies are usually safer and more effective.

General information only — not medical advice. Always read the patient information leaflet and consult a doctor or pharmacist before starting any medication.