Patient 

Information Guide: 

Long-term Opioid 

Therapy for Chronic 

Pain

Department of Veterans Affairs 

and Department of Defense (DoD) 

employees who use this information 

are responsible for considering all 

applicable regulations and policies 

throughout the course of care.
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Introduction

Your health care provider may have prescribed opioid medication to help you manage 

your chronic pain. This patient guide gives you important information about the 

effects of opioids (also called “opiates” or “narcotics”) and outlines what your health 

care provider expects of you and what you can expect from your provider. This 

information is important because opioids can be dangerous if not taken responsibly.

It is important to understand that opioid medication doesn’t work for every person 

or type of pain. While opioids may reduce your pain, they are unlikely to take it away 

completely. You will work with your health care provider to develop a pain care plan 

to identify your goals for treatment. You may be asked to sign an informed consent at 

the beginning of treatment and if changes are made to your pain care plan.

Your health care provider may taper or discontinue your opioid therapy if you do 

not benefit, or if the harms outweigh the benefits. You can still continue to receive 

treatment for your pain through other pain therapies that will be discussed with you.

These guidelines are not intended to represent TRICARE policy. Further, inclusion of 

recommendations for specific testing and/or therapeutic interventions within these 

guidelines does not guarantee coverage of civilian sector care. Additional information 

on current TRICARE benefits may be found at www.tricare.mil or by contacting your 

regional TRICARE Managed Care Support Contractor.
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Prescription opioid medications include

 Codeine 

 Fentanyl (e.g., Actiq®, Duragesic®, Fentora®)

 Hydrocodone (e.g., Vicodin®) 

 Oxycodone (e.g., OxyContin®)

 Oxycodone and acetaminophen (e.g., Percocet®, Endocet®, 

Roxicet®)

 Oxycodone and naloxone (e.g., Targiniq ER®)

 Oxymorphone (e.g., Opana®) 

 Meperidine (e.g., Demerol®)

 Methadone (e.g., Dolophine®, Methadose®)

 Morphine (e.g., Kadian®, Avinza®, Astramorph®,

MS Contin®, Oramorph®)

 Tramadol (e.g., Tramal®) 

 Buprenorphine (e.g., Norspan®, Temgesic®) 

What are Opioids?

Opioids are a type of strong pain relieving medication used to treat moderate to 

severe pain that may not respond well to other pain medications. Patients taking 

opioids need to understand that their pain may not respond to opioids, that initial 

relief may not be maintained, and that the risks of opioids need to be carefully 

balanced against the benefits.

Opioids can have serious side effects if not taken properly.
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The purpose of a pain care plan is to:

 Maximize your health and quality of life

 Increase your level of function and activity

 Decrease the effect of pain on your life

 Minimize the risk of side effects from medications

 Ensure the safe use of opioid medication

The effectiveness of your pain care plan depends, in part, on the strength of your 

relationship with your health care provider. Pain treatment is not just about the 

provider intervention alone, but about the provider and patient (and family) working 

together. There needs to be trust, honesty and good communication between you 

and your health care provider.

Your provider will discuss your pain care plan with you to identify reachable goals 

and to make sure that you are clear about the pain relief and daily function that you 

can expect to achieve when opioids are a part of your treatment. You may be asked 

to sign an informed consent at the beginning of treatment and if changes are made 

to your pain care plan. Informed consent increases the likelihood that your treatment 

will go smoothly.

Some of the things that may be expected of you are: 

 Be honest with the health care team and treat them with respect – the team will 

be honest with you and treat you with respect as well 

 Agree to get all of your prescriptions from one health care provider only

 Be honest and thorough when you report your health, drug and alcohol history

 Speak up! If you have questions and/or concerns, let your provider know

 Before taking any medications, talk with your health care provider about all of the 

health care services you are receiving

Working Together with Your Provider and Your 

Pain Care Plan 
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 Tell all of your health care providers the names of the medical centers/clinics 

where you receive opioids

 Emergency rooms and same day care are not the best places to get treatment 

for your chronic pain – if you have to go to an emergency room, tell the health 

care provider about your pain care plan and all medications that you are currently 

taking

 In case of an emergency, keep a list of all medications you are currently taking

 It is important to follow your pain care plan because your plan may include lab 

tests and other ways to manage your pain

 You will need to meet with your provider one to four weeks after starting opioid 

therapy and up to once every three months or more frequently if needed

 Give your provider a phone number and address where he/she can reach you and 

update your contact information at every visit 

As part of your treatment and to ensure your safety, your provider or other health 

care team members may order urine or blood drug screens on a regular basis. Drug 

screens are conducted to ensure that you are taking your opioid medication as 

prescribed and to ensure compliance with your pain care plan. Lab results will also 

let your provider know if you are taking other medications that might interfere or 

cause problems with your opioid treatment or if your urine or blood contains drugs 

not prescribed for you, such as “street” or illegal drugs and alcohol. 

The Department of Veterans Affairs (VA) and the Department of Defense (DoD) 

medical systems do not use drug screen lab results for law enforcement or 

employment purposes when related to your patient care. However, service members 

need to be aware that providers are obligated to inform commanders about any 

issues that impact the service member’s fitness for duty and to ensure the safety of 

the public.
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Alternatives to Opioid Therapy

It is important to remember that taking an opioid medication to reduce your pain is 

only one part of managing your pain. Opioids alone are not enough to treat your pain 

and to improve your quality of life. Your provider will likely offer additional ways to 

manage pain such as:

 Heat and cold 

therapy

 Stretching

 Exercise

 Massage

 Chiropractic

 Relaxation or stress 

reduction training

 Physical therapy

 Occupational therapy

 Cognitive behavioral 

therapy

 Attention to proper 

sleep 

 Counseling

 Pain care specialist

 Surgery

 Pain school or classes

 Spiritual

 Weight loss

 Nerve stimulation

 Injections

 Acupuncture

 Meditation

 Social support

 Non-opioid pain 

medications (e.g., 

non-steroidal antiinflammatory drugs, 

antidepressants, 

anticonvulsants)

Taking Opioids Responsibly

When taken as prescribed, patients can often use opioid medication to manage pain 

safely and effectively. Because opioid medications can be dangerous, it is important 

that you:

Take your opioid and non-opioid pain medications only as prescribed.

Make sure you take the right dose of medication at the right time. Don’t avoid 

taking your pain medication to save it for a later time and don’t take someone 

else’s prescriptions.

Never take more opioid medication than prescribed. If you take extra doses 

without the direction of your health care provider, you could become very sick or 

even die from an opioid overdose. You may also run out of your opioids before you 

can refill your medication – this may lead to withdrawal symptoms. If you have 

severe, increased or new pain, don’t just take more of your opioids. Call your pain 

treatment provider or clinic to decide on the best care.
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Make an effort to remain in the care of one primary health care provider. 

This will help ensure the right amount and type of medication is prescribed, so you 

have optimal pain management and continued care.

Inform your primary health care provider about any other health care 

that you are receiving from additional providers (e.g., behavioral health, 

interdisciplinary team, providers outside VA/DoD). 

Tell your health care provider about 

all medications and supplements that 

you currently take. Coordination of pain 

management services is important to ensure 

your safety. You should know that your 

health care provider may choose to alter 

your pain management care plan, including 

long-term use of opioid therapy, to take into 

account all care that raises safety concerns.

Inform ALL of your providers that you 

are currently prescribed opioids.

Tell your primary health care provider 

if another provider prescribes an 

opioid for you. Tell your primary health 

care provider within 24 hours or on the next 

weekday if another provider prescribes an 

opioid (e.g., for acute pain after surgery).

Prevent opioid misuse, abuse and 

diversion. Never sell or share your 

prescription opioids or take another 

person’s opioids – doing so can lead 

to criminal charges.

Keep your medications in a safe and secure place. The VA and DoD may not 

replace doses that are lost, stolen or shared with others. 

Please advise your provider 

if you are taking medications 

for depression or anxiety, for 

example:

 Benzodiazepines

 Prozac®

 Paxil®

 Cymbalta®

 Effexor®

 Tofranil®

 Tofranil-PM® (Imipramine)

 Xanax®

 Klonopin®

 Ativan®

 Muscle Relaxers (Soma® or 

Flexeril®)

 Hypnotics (Ambien® or 

Lunesta®)
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Illegal drugs include

 Marijuana not medically prescribed [NOTE: It is illegal for 

patients to possess marijuana on federal property to include 

all VA and DoD facilities]

 Ketamine (Special K, Vitamin K, Cat Valium)

 PCP 

 Cocaine /Crack 

 Heroin

 Ecstasy or MDMA (Molly) 

 Methamphetamine

 Bath Salts 

 LSD 

 Diverted (“black market”) prescription drugs (e.g., opioids, 

benzodiazepines, other controlled substances, steroids) 

 Inhalants (e.g., glue, solvents, lighter fluid)

Get help and support from your friends and family. Your health care provider 

may encourage you to involve your friends and family to learn about opioids. He/

she may also ask for permission to contact your family about your opioid pain care. 

Social support is an important component of pain management.

Don’t drink alcohol or take illegal drugs. It is not safe to drink alcohol or use 

illegal drugs when you are taking opioids. They can impair your ability to manage 

your opioid therapy and cause severe harm or death. If you abuse alcohol or use 

illegal drugs, your provider will encourage you to get treatment for this problem and 

may stop prescribing opioids. Treatment for alcohol or drug abuse will not interfere 

with your ability to get treatment for your pain or other conditions and may be helpful. 
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Withdrawal symptoms can include:

 Stomach cramps

 Trouble sleeping

 Extra saliva

 Tears in your eyes

 Loss of appetite

 Anxiety

 Muscle aches/cramps

 Sweats

 Increased heart rate

 Nausea

 Increased blood pressure

 Runny nose

 Feeling very tired

 “Goose bumps”

Opioid withdrawal

Never change or stop taking any opioid medication without checking with your health 

care provider first. 

If you stop taking opioids suddenly, you may have withdrawal symptoms. If your 

provider asks you to slowly decrease your use of opioids, follow the provider’s 

instructions. A slow decrease often helps to reduce withdrawal symptoms and to 

prevent you from feeling sick. If you think you are having withdrawal symptoms, tell 

your provider. Your provider may be able to give you medication for a short time to 

help control them.

Managing Side Effects and Risks

It is important that you are aware of the risks of taking opioids. It is also important that 

you report any side effects that interfere with your daily activities to your provider. This 

information will help you and your provider to develop a pain care plan that balances 

harms (side effects and risks) and benefits (pain relief and how well you function).
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Possible side effects include:

1. Sleepiness and sluggishness, especially if taken with drugs or alcohol 

can cloud your judgment and slow your reaction time. Because of 

this, you are at risk for falls and accidents while driving, using tools or heavy 

equipment. Driving while on opioids may be considered driving under the 

influence (DUI) in some states. 

2. Mental confusion, bad dreams, hallucinations, agitation, depression 

or seizures. Your provider will need to evaluate the underlying cause(s) if you 

experience these side effects and may need to change your dose or type 

of medication.

3. Slowed breathing that can cause death. This is more likely if you have 

sleep apnea or chronic lung disease and/or if you are on higher opioid doses. 

Slowed breathing or death is more likely if you take more medication than you’re 

supposed to or mix opioids with other prescription medications (such as sleep 

aids, muscle relaxers and tranquilizers) or street drugs. 

If you have sleep apnea, your health care provider may:

 Advise you to use only non-opioid pain therapy

 Prescribe a breathing machine to use when you go to sleep

 Advise you to avoid alcohol and medications that may make sleep apnea worse

4. Allergies. Allergic reactions to opioids are rare but do happen. If you get a 

rash or hives, call your provider or 911 right away. If you become short of breath, 

have throat swelling or feel like you may pass out, tell someone to call 911 

right away.

5. Low levels of testosterone can result in decreased sex drive. For men, 

opioids may decrease the ability to have an erection. People with decreased sex 

hormones may experience depression, anxiety, tiredness, hot flashes and night 

sweats. Low testosterone can also cause loss of muscle mass, weakness, brittle 

bones (osteoporosis) and bone fractures.

6. Drug interactions. A drug interaction may occur when two or more 

medications are taken together. Tell your provider about all of the different 

medications you take, including prescription and over-the-counter drugs, as well 

as herbs or vitamins. 

7. Constipation, itching, sweating, feeling sick, vomiting or poor appetite.
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8. Increased sensitivity to pain also known as hyperalgesia.

9. Women may have irregular or no menstrual periods and should take 

precautions to prevent pregnancy while on opioids. Use effective birth 

control methods to prevent pregnancy during opioid treatment. Tell your provider 

if you are pregnant or plan to become pregnant because of the effects of 

opioids on unborn children. Babies born to mothers taking opioids may develop 

dependence, which can result in symptoms after birth. Women should consult 

with their health care provider to determine which medications they can continue 

taking during pregnancy. Stopping opioids suddenly if you are pregnant and 

physically dependent on opioids can lead to complications during pregnancy.

Other risks include:

1. Physical dependence, tolerance or addiction to opioids. Physical 

dependence means you will experience withdrawal if you stop taking opioids 

suddenly. Tolerance means you need to take more of the medication to get the 

same effect. Addiction means you are not able to control your use of opioids 

even if you wanted to, which might result in harmful outcomes.1

2. Increased risk of death. Opioids are one of the primary prescription drugs 

associated with death in the United States.2 Death is more likely when you take 

larger doses of opioids because opioids may cause respiratory depression.

3. Immune system changes. Your body’s immune system helps fight infections. 

Opioids may weaken the immune system. Long-term opioid use may result in 

infections or immune-related illnesses.

Filling Opioid Prescriptions and Safe Storage

 Fill all of your opioid and other prescriptions at the same pharmacy and fill your 

prescription in person if your health care provider asks you to do so

 Ask your health care provider how to refill or renew your opioid prescriptions

 Check with your provider to ensure you know when (i.e. days and times) your 

prescription can be refilled

 If you pick up your prescriptions at the pharmacy, contact your health care 

provider at least three business days before your next opioid prescription is due

 Check with your provider to see if you are eligible to receive refills through:
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− My HealtheVet (myhealth.va.gov) once you have been verified to use the 

prescription refill section of MyHealtheVet

− TRICARE Pharmacy Program (express-scripts.com/TRICARE/)

When ordering by mail:

 Contact your health care provider or pharmacy at least 10 business days before 

your refill is due

 Receive all your mailed prescriptions at a safe address – if you don’t have a safe 

address to receive your opioids by mail, pick them up at the pharmacy

 Make sure that no one else can sign for or pick up your prescription

Storage of your opioid prescriptions: 

 Keep your opioids in a safe, locked place, out 

of reach of children, family, visitors and pets

 Do not leave medications in the bathroom or 

near the sink

 If you are concerned about the safety of 

storing medications in your home, ask your 

pharmacist about the proper way to store 

your medications

 Store medications out of direct sunlight in a 

cool dry place

 Always store your opioids in the original 

labeled container; this will also help answer 

any questions about your medications if you 

travel 

 Never combine different medications into one bottle

Dispose of expired, unused, unneeded prescription drugs safely 

and securely: 

 Both the DoD and VA have implemented programs to allow for the return and 

appropriate disposal of extra or unwanted medications

If someone steals your 

opioid medication or 

prescription, report the 

theft to the police. If you will need 

a refill or new prescription sooner 

than usual, give your provider and 

pharmacy a copy of the police report, 

so they will know why there is a need 

sooner than expected. It is helpful 

to make sure no one else can sign 

for your prescription or take it when 

delivered by mail.
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 Take advantage of the VA’s drug mail-back program or the drug take-back 

program in your community 

 Do not flush unwanted or unneeded drugs down toilets or drains or throw them in 

the trash – this can harm the water supply and wildlife

Prescription Drug Monitoring Programs

The Prescription Drug Monitoring Program (PDMP) is designed to identify potential 

unsafe behavior regarding controlled medications and prevent or decrease the risk of 

over utilization. Most states have programs that track prescription drugs to identify 

and address inappropriate or unsafe patterns of controlled drug use.

For your safety, your provider and pharmacist will monitor when you renew and refill 

your opioids, both within the VA and DoD and, when allowed or required by law, 

outside the VA or DoD.

References

1 U.S. Department of Health and Human Services Centers for Disease Control 

and Prevention. (2016). Prescription Opioids: What You Need to Know Fact 

Sheet. Retrieved from 

www.cdc.gov/drugoverdose/pdf/aha-patient-opioid-factsheet-a.pdf

2 Opioid Therapy for Chronic Pain Working Group, Department of Veterans Affairs 

& Department of Defense. (2017). VA/DoD Clinical Practice Guideline for Opioid 

Therapy for Chronic Pain. Version 3.0. Retrieved from 

https://www.healthquality.va.gov/guidelines/Pain/cot/VADoDOTCPG022717.pdf
Updated June 2017 by Defense Centers of Excellence for 

Psychological Health and Traumatic Brain Injury 

PUID 4314