Opioids

Opioids are second-line medications reserved for moderate to severe knee and hip osteoarthritis (OA) pain that does not respond to adequate trials of other therapies (acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), tramadol, duloxetine).

Opioids are not typically used to treat OA pain. The small to moderate beneficial effects of opioids are outweighed by significantly increased risks of adverse events.

Opioids may also be used for short periods of time to help treat pain associated with inflammatory arthritis. There is no data regarding the benefits and risks of opioid use for inflammatory arthritis beyond six weeks.

Given the limited benefit of opioids in the treatment of arthritis and the risks of adverse events the medication should be discontinued if a meaningful benefit is not achieved relatively quickly.

Opioids are typically taken orally. One opioid (fentanyl, Duragesic®) can be administered by a patch applied to the skin, but this medication is not typically used to manage arthritis pain.

Short acting: 

• Take every four to six hours when needed for pain

Long acting:

• 12-hour formulations: Take every 12 hours for pain

• 24-hour formulations: Take once daily for pain

Your prescriber will likely start therapy with a short-acting agent at a low dose, gradually increasing to the lowest effective dose to minimize adverse events. Long-acting agents may be used if you are on a stable opioid dose, your pain is effectively controlled without causing adverse events and your prescriber decides you will require long term therapy with opioids.

Opioids reduce pain by binding to opioid receptors in the central nervous system. 

Opioids typically begin to work within one hour.

Do not take opioid medications if you have an allergy (e.g., codeine, morphine or meperidine allergy).

Opioids should be used with caution if you have chronic obstructive pulmonary disease (COPD) and/or other lung conditions. Please consult your healthcare provider if you have any lung conditions.

Your prescriber may wish to avoid using opioids to manage your condition if you have a history of drug and/or alcohol abuse. Please discuss this with your prescriber.

A number of opioid products, as noted above, also contain acetaminophen. If you are taking other acetaminophen products, please speak to your healthcare providers to ensure that you are not taking more than the maximum daily dose of acetaminophen (max: 4,000 mg per day).

Nausea and vomiting, constipation, sedation or drowsiness, confusion, urinary retention, dry mouth, allergic reactions (e.g., rash).

Physical dependence and addiction to opioids can occur with long-term use and opioid use should be limited to short-term use. 

Excessive or high doses of opioids can cause respiratory depression and respiratory arrest leading to slow and shallow breathing which can cause death.

Tolerance to opioids may develop with regular use of these medications. This means that you will require higher doses in order to achieve the same level of pain relief. Prolonged use of opioids and taking the medication other than how your prescriber has instructed increases the risk of opioid dependence. This can lead to improper use of these medications. Research has shown that people who take opioids at an appropriate dose for their level of pain are at low risk of misusing the medication. If you have concerns or questions about tolerance and dependence, please talk to your healthcare provider.

To prevent constipation while taking opioids you should increase your intake of water and fluids. Increasing the amount of fibre in your diet is also helpful. Your prescriber may recommend a laxative and/or stool softener to help relieve constipation if water and fibre are not effective.

To reduce stomach upset, consider taking opioid medications with food.

If you experience drowsiness and sedation while taking opioids, please be cautious about operating hazardous machinery, including automobiles, until you are reasonably certain that opioid therapy does not affect your ability to engage in such activities.

People who are experiencing excessive sedation or drowsiness may consider avoiding strenuous activities or taking the medication closer to bedtime.

Avoid consuming alcohol or taking other medications, especially benzodiazepines, which also cause drowsiness to reduce the risk of oversedation, confusion, and loss of memory.

Take opioid medications as instructed by your prescriber using the lowest effective dose, for the shortest duration necessary.

Routine blood tests or monitoring are not normally required while you are taking opioids. Your healthcare provider should meet with you regularly to ensure that your opioid is adequately controlling your pain and not causing adverse effects.

Store this medication at room temperature (15 to 30 degrees Celsius) and keep it out of reach of children.