Counseling Patients on Side Effects and Driving When Starting Opioids #248

Abstract

Background Opioids have side effects that can limit their acceptability to patients. This Fast Fact gives expert opinion recommendations about patient counseling when initiating opioid therapy. See Fast Fact #83 for a discussion of patient fear of opioids, including addiction and tolerance. Key Symptoms Patients should be reassured that most opioid side effects are short-lived or otherwise manageable, and they should seek help immediately for intolerable side effects.

Chemotherapy-induced Peripheral Neuropathy in Pediatric Cancer Patients

“…Specific pharmacotherapies should be elucidated, including potential dose-limiting side-effects, when indicated; opioid therapies should only be initiated after appropriate counseling, including differentiating tolerance, dependence, and addiction [98]. As with any chronic symptom, ongoing attention should be paid to the connection between intervention and improvement in function/independence; individual interventions (e.g.…”

“…As with any chronic symptom, ongoing attention should be paid to the connection between intervention and improvement in function/independence; individual interventions (e.g. physical therapy, acupuncture, anticonvulsant pharmacotherapy) and symptoms should also be reevaluated at regular intervals in the context of quality-of-life assessments [98]. …”

Assessing the practice of palliative care doctors: what driving advice do they give patients with advanced disease?

“…Deciding when an opioid‐naïve patient is safe to drive after taking a short‐acting oral opioid is challenging, hence the variability of responses seen in this scenario. An opioid‐naïve person may experience side‐effects, such as sedation, light‐headedness and slowed reaction time after taking an opioid . Translating this into apparent effect on driving safety is not simple.…”

“…An opioid-naïve person may experience side-effects, such as sedation, light-headedness and slowed reaction time after taking an opioid. [7][8][9] Translating this into apparent effect on driving safety is not simple. The studies available are small and inconsistentone small double blinded study (n = 18) assessed on road driver performance after taking either a non-steroidal anti-inflammatory, The Australian driving guidelines do not outline clear standards for opioid use, so consensus cannot be determined.…”

Driving Under the Influence of Opioids

“…It is generally established that patients who recently initiated or escalated opioid doses are likely to demonstrate psychomotor and/or cognitive impairment, and therefore should not drive until these adverse effects have resolved [6‐8]. Patients are often counseled that with the exception of constipation, most adverse effects from opioids, including sedation, are short‐lived and diminish over time [9].…”