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Opioids in palliative care

Opioids are offered frequently in palliative care to help reduce pain and breathlessness. The initiation and titration happens in wards, clinics and in outpatient settings. As their prescription sometimes forms part of a much wider consultation on disease status and other important matters in the palliative care context, it can be difficult for a patient (and their carer) to take in all the relevant information with regard to taking these strong medicines. Information tends to be verbal and is not always backed up by written guidance. Yet these are complicated medicines to take with varying dosing regimens and they can carry a lot of stigma and even fear for some people. Patients (and carers) can be left concerned or frightened about possible side-effects, addiction potential, or even feel that taking these drugs implies they are reaching the end of their lives and this can adversely affect compliance. NICE have recommended that strong opioid prescribing in palliative care should be backed up with written guidance. See also:

The following patient manuals on taking opioids in palliative care settings represent a useful take-home supplement to consultations where opioids have been discussed, considered and/or prescribed. It uses a ‘Frequently Asked Questions’ model, which patients and carers can dip in and out of at a time that suits them. There is a diary at the end that they can fill in and bring to the prescribers attention, for instance to show how many doses of fast-acting breakthrough opioid they have taken in the last few days.

The different opioid manuals on the AWMSG website give the prescriber a choice: There is a version that uses MST as an example of a sustained-release opioid, and one that uses Morphgesic SR as an example; this is because different health boards recommend different forms of oral sustained-release morphine as a first-line option.

Patient Information Manual - Opioids in Palliative Care (Morphgesic SR)
Patient Information Manual - Opioids in Palliative Care (MST)

Taflen Wybodaeth i Gleifion - Opioidau yng Ngofal Lliniarol (Morphgesic SR)
Taflen Wybodaeth i Gleifion - Opioidau yng Ngofal Lliniarol (MST)

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