Morphine and strong opioid information MY Medicines Helpline: 01924 541398 Monday to Friday 9am to 5pm Use this space for patient ID label Name: DOB: NHS Number: Hospital Number:
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
Option 1: Is a fast acting (or immediate release) medicine which is often prescribed in liquid form An example of this is called Oramorph (the tablet form is called Sevredol), or you might be prescribed a liquid called Oxycodone. (This is also available in capsule form which is also known as Oxynorm, Lynlor or Shortec). This is very similar and works in the same way as the morphine preparations. 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 20-30 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 30-60 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 2a: 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. Option 2b: are long acting opioid patches which deliver continuous background pain relief. Fentanyl and Buprenorphine can be delivered in this way. The patches need changing every 3 days, twice weekly or once weekly depending on the preparation. You may still require an immediate release preparation too. 3
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, when used appropriately for pain management it is well known that patients do not become addicted to it. 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
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. You may need to take other types of painkillers such as paracetamol and medicines for inflammation or nerve pain in addition or instead of the Morphine. 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
Can I drive while taking opioids? 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 came into force on the 2nd March 2015. It is illegal to drive with legal drugs in your body of it impairs your ability to drive or if taking in excess of specified levels. If the medicine is taken in accordance with instructions from your GP or as advised on the patient information leaflet, it is your responsibility to judge whether you are fit to drive. It is advisable to carry a copy of your prescription with you. If in any doubt about your ability to drive, it is safer not to drive. 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 6
their embassy in the UK. Please ask your doctor or nurse about the details of this in plenty of time before your holiday. You may want to switch your immediate release opioid for breakthrough pain to a tablet or capsule form as the restrictions on quantities of liquids in your hand luggage also apply to medicines. Other information Can somebody else collect my strong opioids from the pharmacy for me? Yes, a responsible person over 16 years of age, with some form of identification can do this. They must sign the prescription to show that they are collecting the opioids and their relationship to you. If possible, telephone the pharmacy to tell them who will be collecting your medicines on your behalf. What other advice about taking my medicines is important? Always keep an up to date list of your current medicines, including ones you buy from the pharmacy, supermarket, via the internet and from health food shops. Take this to all health related appointments and if you are admitted to a hospital or hospice. Do not stop taking your prescribed medicines without discussing it with your prescriber. Never let other people take any medicines that have been prescribed for you. Seek advice if you are unsure about anything. How should I store my opioids at home? They should be stored securely closed in the original container with the label intact and out of the sight and reach of children and pets. They should be stored away from direct sunlight, heat and moisture in a safe place where you or your carer can easily find them. 7
How should I dispose of unwanted opioids? For used patches only - fold with the sticky sides together, put it back in a patch wrapper or wrap in tissue and throw into a rubbish bin where children and pets cannot get hold of them. Then wash your hands. The used patch may still contain some opioid. Other unwanted opioids (including unused patches) must not be flushed down the sink or toilet or placed in a rubbish bin. Return them to your pharmacy for safe disposal. 8
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 immediate release opioid requirements: Date Time Dose and drug Did it work? 12 th July 08.00 am 2.5mg Oramorph Yes 9
Record of immediate release opioid requirements: Date Time Dose and drug Did it work? 10
Questions/concerns you may wish to ask the doctor or nurse when you next see them: 11
Relevant contact numbers that may be helpful: MY Medicines Information Helpline: 01924 541398 Monday to Friday 9am to 5pm GP: Community District Nursing Service: GP Out of Hours Medical Provider: Community Palliative Care Team: DVLA: 0872 494 1000 Contact details for Help and Support Groups Macmillan Cancer Support: Tel: 0808 808 0000 http://macmillan.org.uk/cancerinformation 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: 0113 234 4150 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: 01924 542972 or email: pals@midyorks.nhs.uk 1665b Updated Feb 2018 Review Date 2021 Dewsbury and District Hospital Halifax Road, Dewsbury WF13 4HS Pinderfields Hospital Aberford Road, Wakefield WF1 4DG Pontefract Hospital Friarwood Lane, Pontefract WF8 1PL 0844 811 8110 / 01924 541000 @MidYorkshireNHS TheMidYorkshireHospitalsNHSTrust www.midyorks.nhs.uk Created by: The Mid Yorkshire Design and Print Team