The Mid Yorkshire Macmillan Specialist Palliative Care Team

Transcription

1 The Mid Yorkshire Macmillan Specialist Palliative Care Team Morphine and Strong Opioid information leaflet Information for patients/carers

2 The mere mention of Morphine can be enough to conjure up all sorts of negative thoughts in patients and their family members. Some people may be afraid of becoming a drug addict while others may think that only people who are ready to die should take Morphine. The reality is that Morphine and other opioids that work in the same way such as Oxycodone, is effective and safe for the treatment of pain. Living with pain can take a toll on all aspects of your life. Fortunately, almost all pain can be eased with the drugs available today. No-one should suffer because they are afraid to use Morphine or other opioids. This leaflet will hopefully help to improve your understanding of these drugs. What is Morphine? Morphine is a strong pain killing drug. It works very well on many types of pain, although it is most commonly associated with cancer pain. It is also reduces the discomfort of breathlessness. Morphine belongs to a group of painkillers called opioids. Morphine is the most commonly used opioid, but there are also several others, for example Codeine, Tramadol, Oxycodone, Diamorphine, Buprenorphine or Fentanyl. These can be as effective as Morphine but occasionally one may suit a particular pain or patient more than another. We can also give painkillers in a number of different ways. For example, some can be supplied as a patch that sticks to the skin or as a dissolvable tablet to use in the mouth or spray. How do I take Morphine? Your doctor,nurse or pharmacist in the community can also provide help and support regarding the administration of medicines. You can be given one of two options; both options are used to work out the correct dose of pain medication specifically for you. The process is sometimes referred to as titration. 2

3 Option 1: Is a fast acting (or immediate release) medicine which is often prescribed in liquid form called Oramorph (the tablet form is called Sevredol), or you might be prescribed a liquid called Oxynorm. (This is also available in capsule form which is also known as Oxynorm). This is very similar to Oramorph and works in the same way. This fast acting Morphine is taken by mouth or if you have a tube leading to your stomach, then the liquid form is given via the tube. The Morphine starts working quickly, after about minutes. It reaches its peak effect after 3-4 hours and gradually wears off. Your doctor or nurse may suggest you take this regularly every 4 hours over a 24 hour period. Wait about minutes after taking the extra dose of quick acting Morphine. If after this time you still have pain, take a second dose. If you need more than two or three extra doses of quick acting Morphine in a day, tell your doctor or nurse. Your doctor or nurse may use the term breakthrough pain to describe occasional, unpredictable pain breaking through despite you being on regular pain relief. Additionally, you can have rescue or breakthrough of the same medicine at the same dose if you get additional pain. Option 2: Is a long acting form of Morphine (sustained release). This contains a formulation that ensures that the Morphine is slowly and gradually released over 12 hours and can help to prevent ongoing pain. Long acting Morphine is usually taken twice a day, for example 10am and 10pm. You will still be able to take your fast acting Morphine in between for any breakthrough pain. 3

4 What happens when l start taking Morphine? We always start with the lowest possible dose to allow your body to get used to it. Your pain should improve quickly, although it may take a little while to find the right dose for you, hence the need to titrate your Morphine. What are the side effects? Morphine can make you constipated and most people who take it may need laxatives. It can also make you feel slightly sick when you first take it. Your doctor may give you something to stop this feeling, but it usually only lasts a few days. Morphine may also make you feel sleepy for the first few days while you are getting used to it or when the dose is increased but our bodies can usually adapt gradually. However, if you are already taking painkillers such as Codeine they can often be equal in effect to a low dose of Morphine, so changing to Morphine should not feel especially different. It is important to remember that although these are common side effects it does not necessarily mean you will experience these listed side effects. Will I become addicted to Morphine? No. If you no longer need to take Morphine, your doctor will reduce the dose gradually. Do not stop taking Morphine suddenly. Is Morphine only used at the end of life? No. Morphine is given for different sorts of pain. This may be as a result of cancer, heart disease or other illnesses. Treatment with Morphine may be needed to allow you to continue having as comfortable a life as possible. You will be able to go on taking Morphine for as long as you need to. Patients can become tolerant to doses and the dose can be increased if needed. 4

5 What do I do if I am still in pain after taking my Morphine? Although Morphine is a strong pain relief medication, it does not work for all types of pain. Your doctor or nurse will want to establish whether the pain you have is relieved with the Morphine; if it helps slightly then it may be that the amount you are taking is not a high enough dose, it may be that you need to have your Morphine increased to a higher dose, or if the Morphine does not help the pain other treatment options will be discussed with you. How will I know if the Morphine is not going to work for some of my pain? You may still have pain despite taking bigger doses of Morphine and may feel unwell in one or more of these ways: 1. More sleepy than usual. 2. Feeling sick more of the time. 3. Restlessness or jumpiness. 4. Bad dreams. Do not worry if this happens. Tell your doctor or nurse. Your doctor may reduce your dose of Morphine and suggest other treatments to help the pain. Will Morphine affect what I do daily? You should find you can carry on doing the things you want to, when you are taking Morphine. In fact many of our patients find they can do more because their pain is better controlled. 5

6 Can I drive? With regards to your Morphine, you may well be able to drive when you have been taking the same dose of medicine for 5 days or more. If you are sleepy or the side effects are bothering you, then you should not drive and to speak to your medical team. We would advise you to discuss this with your doctor, who can help you make a judgment. If your doctor expresses concerns about your fitness to drive, you should contact DVLA. A new offence of driving with certain controlled drugs above specified limits in the blood is expected to come into force on the 2nd March Once this comes into force, please contact DVLA for further information. Will l still be able to have an alcoholic drink? A small glass of wine, beer, sherry or whisky may help you feel better and improve your appetite. It is best to avoid taking more than this as you may become too drowsy. Can I take Morphine or other opioids abroad? You would need to take opioids in hand luggage and get a letter from your doctor which must confirm your name, your travel itinerary, a list of your prescribed controlled drugs, dosages and total amounts for each drug. You don t need a licence if you carry supplies for less than 3 months but you should have a letter from your doctor with the information above. You might have to show the letter when going through customs. You should also check the regulations for controlled drugs with each country you are travelling to by contacting their embassy in the UK. Please ask your doctor or nurse about the details of this in plenty of time before your holiday. 6

7 To help your doctor or nurse work out the correct dose of medication that is the most effective for your pain they may ask you to keep a diary. The first line is an example of how to record what you have taken. Record of Oramorph (Sevredol), Oxynorm (Oxycodone) requirements: Date Time Dose and drug Did it work? 12 th July am 2.5mg Oramorph Yes 7

8 Record of Oramorph (Sevredol), Oxynorm (Oxycodone) requirements: Date Time Dose and drug Did it work? 8

9 Record of Oramorph (Sevredol), Oxynorm (Oxycodone) requirements: Date Time Dose and drug Did it work? 9

10 Record of Oramorph (Sevredol), Oxynorm (Oxycodone) requirements: Date Time Dose and drug Did it work? 10

11 Questions/concerns you may wish to ask the doctor or nurse when you next see them: 11

12 Relevant contact numbers that may be helpful: GP: Community District Nursing Service: GP Out of Hours Medical Provider: Community Palliative Care Team: DVLA: Contact details for Help and Support Groups Macmillan Cancer Support: Tel: Provides specialist information on all aspects of cancer and treatments. Also provides information on the practical and emotional side of living with cancer. CRUSE (Leeds): Tel: Provides specialist bereavement advice and support. Please remember, your GP and district nurse will provide you with additional help and support contacts. We are committed to providing high quality care. If you have a suggestion, comment, complaint or appreciation about the care you have received, or if you need this leaflet in another format please contact the Patient Advice and Liaison Service on: or pals@midyorks.nhs.uk To contact any of our hospitals call: To book or change an appointment call: a Published Oct 2014 Review Date 2017 Design: The Mid Yorkshire Hospitals NHS Trust - design and print dept