Introduction

Opioids are medicines used to relieve moderate to severe pain. Examples include fentanyl, hydromorphone, and morphine. Heroin is an example of an illegal opioid. They may be used for long-term pain, such as for cancer. Or they may be used when other treatments haven't worked. They don't cure a health problem. But they may help you manage the pain and function better. Your doctor will talk with you about how they fit into your overall treatment plan.

Doctors follow a strict set of rules for giving opioids to their patients who have long-term (chronic) pain. This is because they can be dangerous. They can cause problems if they are not used correctly. They can also be misused. And they may not do a better job of treating pain than non-opioids, like acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen.

What happens before you get a prescription?

Your doctor may talk with you about your pain history. Your doctor may ask about your family history. You may have a physical exam. You may also see a pain specialist. This helps your doctor decide if an opioid is right for you.

Your doctor will also review your history of opioid use. Most provinces have a program that tracks prescriptions. If your province does, your doctor will check it to see if you've had prescriptions for opioids before.

You may have a urine test to check for opioids and other drugs in your system. You may have a pregnancy test. Talk to your doctor about safety if you are pregnant or could become pregnant.

When you're prescribed opioids, your doctor will discuss your treatment plan with you. That includes the risks and benefits of opioid medicines. Your doctor will tell you how much pain relief and improved ability to function you can expect. The goal is to take the lowest dose that improves your pain for the shortest amount of time. Your doctor will also talk with you about other things you can do to help relieve pain. Your doctor may suggest different medicines or other options, such as cognitive behavioural therapy (CBT), steroid injections, physiotherapy, or ways to reduce stress.

It's always a good idea to ask questions before you get a new prescription. This is especially true when you get a prescription for an opioid.

Some questions to ask your doctor include:

• Why do I need this medicine? Is it right for me?
• How long should I take this medicine?
• What can I do to help with side effects, like constipation?
• How should I store this medicine? What should I do with leftover or unused opioid medicine?
• Do I need a take-home naloxone kit?
• How can I prevent an opioid emergency or overdose?

You and your doctor will talk about your responsibilities. You may sign a written agreement. You will agree to take your medicine exactly as your doctor tells you to. You'll also agree to be careful with it and not to share it with others.

What happens after you start to use your medicine?

Regular follow-up visits to your doctor will help you and your doctor make sure that the medicine is the right treatment for your pain. At every visit, your doctor will check these things:

• Is your pain being controlled?
• Are you better able to function and be active?
• Are you having any side effects, like constipation, nausea, or being too sleepy?
• Are the non-opioid pain control measures working? Are there other things you can try?
• Are there any signs that you are misusing your medicine?

While you are taking an opioid, you may have drug tests and prescription history checks from time to time.