opiates, in particular, oxycodone is the number one cause of deaths from prescription medications in Australia
mixing opiates for acute pain, or use with pregabalin or gabapentin1) requires close observation as there is a risk of fatal resp. depression, especially in those who are obese or have obstructive sleep apnoea
pethidine is no longer regarded as having a significant role in the management of ED patients, and thus, many ED's have decided to stop using it because of its tendency for substance abuse and that there are more effective options.
repeated doses of pethidine runs the risk of accumulation of its metabolite causing seizures.
indications for pethidine are very limited and usually restricted to:
true type I hypersensitivity reactions to opiates (but Anaphylaxis to opiates is actually quite rare)
certain rare conditions such as systemic mastocytosis which is associated with true anaphylaxis to NM blockers and opiates.
chronic pain patients should be considered for referral to a chronic pain service
patients requesting pethidine should be considered for referral to an addiction medicine specialist.
patients thought to have allergies to opiates should be referred to allergy testing to clarify this, either:
skin testing (eg. Dr Karl Bleasel, RMH Immunology, fax: 03 9349 3199) - may take 2-3 months to arrange
morphine RAST test (biochem serology blood tube) - takes 2-3 weeks for results.
if opiates are needed for pain management:
adverse reactions related to dose, or known side effect profiles such as nausea, itch and dysphoria, should be managed with careful attention to dose, speed of administration and pre-emptive management of expected side effects, and the use of non-opiate analgesics.
opiates are generally a poor choice for migraine headaches and most cases of low back pain
the oral route should be used if not contraindicated and patient likely to tolerate oral dose and rapid onset not required: