Home' Australian Pharmacist : Australian Pharmacist May 2013 Contents 50 Australian Pharmacist May 2013 I ©Pharmaceutical Society of Australia Ltd.
Continuing Professional Development
COUNSELLING IN PRACTICE
If my mother starts morphine now,
will it still work if the pain gets
Dose ceilings of opioids for good pain
control are variable yet high and doses
can largely be pushed if the dose no
longer maintains the analgesic effect.11
Tolerance to opioids can occur with
ongoing exposure and it occurs in the
absence of addiction. While increasing
the dose will assist in responding to the
pain, another strategy to address the
problem of tolerance is to switch to an
alternative opioid (which is known as
Some patients will link the dose increase,
due to tolerance to the medicine, with
disease progression. This is false and it is
important that patients (and their carers)
are encouraged to refer these anxieties to
crisis. If the focus of the pain goes away,
the opioid must be slowly withdrawn.
Most importantly, physical dependence is
How can I make sure the dose taken
will be safe and not an overdose?
Opioid doses are titrated according to
changes in function, pain severity and the
development of unpleasant adverse effects.
Opioids are a high risk group of medicines
because they have an increased risk of
causing significant harm when dosing
mistakes occur.12 While the frequency of
errors with opioids may be similar to other
medicines, the consequences of the mistake
may result in hospital admission or even
accidental death. Provided the therapy is
closely monitored, an overdose is unlikely.
As there are many elements to pain
management, it is likely that the types
of medicines and the formulations used
will be adjusted over time and packets of
partly unused medicines will accumulate.
Patients may be tempted to keep these
unused medicines for later use. To avoid
patient confusion between new and
previously prescribed medicines, they
should be encouraged to return unused
medicines to the pharmacy for disposal.
The addition of an opioid may trigger a
referral for a Home Medicines Review.
Will my mother become addicted to
Delays in commencing opioids for the
management of pain may also result from
an unfounded risk of addiction. This may
originate from the patient, carer or
healthcare professional. Often the terms
addiction, physical dependence and
tolerance are used interchangeably when
they are actually quite different.2,9
When opioids are used in the absence
of a medical condition, they can
produce euphoric effects. Under these
circumstances, people can become
addicted to opioids. For those people
using morphine for a medical reason
(such as pain or dyspnoea), opioids
operate in a different way. Under these
circumstances, the medicine neutralises
the symptom and does not give the same
degree of euphoric effect as someone
who is using it in the absence of a
Sudden withdrawal of opioids, when
used consistently over time, will result
in a physical response characterised
by symptoms such as tremors and
agitation. This is a normal response to
chronic opioid therapy and is known as
physical dependence. The opioid must
be used continuously around-the-clock.
Stopping opioids abruptly can result in a
Where can I get more information?
Analgesic Therapeutic Guidelines and
Palliative Care Therapeutic Guidelines
Expert, unbiased and objective therapeutic information
tailored for health professionals.
Cancer Council Australia
Valuable resource for consumer printed information.
Helpline: 13 11 20
Cancer Institute NSW
eviQ website: information resources for health professionals
and consumers. The calculators on eviQ are particularly
useful to assist with dose conversions between opioid
www.caresearch.com.au Palliative care information and evidence including pain and
analgesia information. All materials are reviewed for quality
Professional group available for pharmacists.
Carers Australia and
Young Carers Australia
Advisory line: 1800 242 636
National Comprehensive Cancer Network www.nccn.org
Refer to 'Adult Cancer Pain' -- a comprehensive overview for
National Prescribing Service
Independent evidence-based information on a range of
topics for healthcare professionals and consumers.
Palliative Care Australia
www.palliativecare.org.au A range of information resources tailored for both health
professionals and consumers.
of opioids, when used
consistently over time,
will result in a physical
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