Opiate/opioid products are medicines with effects similar to opium. They act by stimulating opioid receptors in the brain and nervous system to reduce sensitivity to pain.
There are a large number of opiate/opioid medicines, however two of the most commonly used via prescription and over the counter in pharmacies, are codeine and dihydrocodeine.
Codeine/dihydrocodeine medicines are available either on prescription from an NHS or private GP; or, in relatively lower doses over-the-counter, at a pharmacy, and sometimes combined with aspirin, ibuprofen or paracetamol.
They are intended to be used for a limited period of time to treat pain that does not respond to standard effective medicines like aspirin, ibuprofen and paracetamol.
However some people with chronic issues can take these medicines for longer. This factsheet is intended to help anyone taking these medicines understand their safe use and risks associated with long term use or misuse.
Although opiate medicines will vary in how powerful they are, they are all sedative medicines that can depress the nervous system, and so slow down body functions and reduce physical and psychological pain. They can also be highly addictive.
Although they are normally safe to take if you follow your doctor/pharmacists instructions and not all people become dependent, some people who have used opiate medicines regularly or incorrectly can become dependent upon them.
If they are taken primarily to get high and to feel better emotionally, the risk of addiction will be greater.
Although the different opiate medicines vary in how powerful they are, and we are not here listing all their medical uses, they are often aimed to have the following effects:
- Relief of pain
- Reduced coughing (Codeine Linctus is licensed only for cough not for pain relief)
- Feeling sick or vomiting
- Feeling sleepy
- Dizziness and vertigo (a sensation of spinning)
- Heart problems
- Breathing difficulty or short shallow breathing
- Muscle stiffness
- Symptoms of low blood pressure which include feeling dizzy and tired
An opiate painkiller that has been properly prescribed or has been obtained from your GPHC registered pharmacy is subject to stringent controls, as with any other medicine, so you can be sure of its strength and that it has not been tampered with.
Certain opiate medicines have additional specific non-opioid effects, which may be described by the prescriber, and will be described in the patient information leaflet.
Overuse of codeine when it is taken already combined with one of the simple analgesic drugs, can lead to paracetamol, aspirin or ibuprofen poisoning and even death.
Whilst paracetamol, ibuprofen and aspirin may seem harmless in normal doses, they can cause really serious problems in high doses - with risks of kidney failure, liver failure, and of severe damage to, or bleeding from, the stomach, which can be fatal.
There is a greater risk of overdose and death if you are mixing opiate medicines with other drugs that suppress breathing such as alcohol, benzodiazepines (like diazepam or Valium), and/or other opiate drugs.
There's a particular risk of death due to inhaling vomit – because opiate medicines can sedate you, can add to the risk of vomiting, and can stop you from coughing properly. The vomit blocks the airways or later leads to pneumonia.
In pregnancy, regularly having taken high doses of opiate medicines for a continuous sustained period of time in the lead up to delivery can lead to withdrawal symptoms for the newborn baby. Opiates should never be used in pregnancy.
Mixing any opiate medicine with alcohol, or with other sedatives such as benzodiazepines, can have serious consequences: an overdose is more likely, and this can lead to a coma or respiratory failure and death.
Take the medicine exactly as your doctor or pharmacist has indicated. And be aware…
- If the medicine is required for longer periods and in higher doses than recommended, and if stopping the medicine makes you feel unwell but feels better when you restart again – speak to the doctor immediately.
- If taking these medicines for headaches for more than three days it can make them worse.
- If any unwanted side effects persist then seek advice from doctor / pharmacist. Unwanted side effects can be reported by the internet www.yellowcard.gov.uk / Free phone 0808 100 3352 (Mon- Fri 10am-2pm).
- Seek medical advice if symptoms persist or worsen – or if stopped taking the analgesic and you feel unwell.
Not everyone who takes opiate based medications will become dependent, each patient is different and their bodies behave in different ways.
However, It is possible if one or more of the following are true:
- Difficulty stopping the medicine
- Feeling unwell when stopping, and better when you restart the medicine.
- Taking it for reasons other than its intended ailment, e.g. emotional reasons or to get high.
- Needing to take more of the medicine to get the same effect (tolerance).
- Taking the medicine anyway despite being aware of the negative adverse effects it is having on you.
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