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Understanding Long-Acting Opioids

Long-acting opioids are medicines that slowly release opioids into your body, keeping steady amount in your system throughout the day. For that reason, you shouldn’t expect them to provide quick relief of pain in the moment. Instead, they work in the background to prevent pain spikes and to control your overall pain level.

Common examples are MS-Contin, Morphine ER, OxyContin, and fentanyl (Duragesic) patches. To see your long-acting opioid, go to your Medicine Cabinet.

How long do they last?

Each medicine is a little bit different in terms of how long they take to work, and when they wear off:

Fentanyl patches take time to absorb through your skin, so it can take up to a day for it to get fully into your system. For this reason, if you are just starting this medication (or increasing the dose), you won’t feel the full effect for about a day. The patch usually starts to wear off after 3 days, which is why most prescriptions say to change the patch every 72 hours. If you take your patch off sooner than this, it will wear off in about a day.

Methadone isn’t a “slow release” version of an opioid, but it stays in the body for a long time. For this reason, it is used like other “long-acting” opioids to get predictable, long-lasting pain control. Most people will notice pain relief about an hour after taking methadone. It will take 3 days before you feel the full effect of methadone, when the medicine reaches what’s called a “steady state.” Until you get the full pain relief from methadone, you may need to use your short-acting opioid more often to control your pain.

How to use your long-acting opioids

Take them on a regular schedule, whether or not you feel pain. You may not notice an immediate difference after taking them but keep using them on a regular schedule to help with your overall pain control.

NEVER change the dose of your long-acting opioid on your own. If you feel like your long-acting opioid is too much, or not enough, talk to your care team about whether you need a different dose, or a different medication.

NEVER stop taking your long-acting opioid suddenly. This can cause symptoms of withdrawal, including pain, nausea, diarrhea, sweating, and anxiety. If there is a time that you don’t need your long-acting opioid anymore, your care team can help you come up with a safe plan to taper it.

Pill long-acting opioids

oxycodone (OxyContin), morphine (MS Contin, Morphine ER), or methadone (Dolophine)

Here are some important things to remember about taking long-acting opioids in pill form:

Here are tips to help:

Connect taking your medicines to activities you do at the same time every day like brushing teeth, a meal, or going to bed
Set a timer on your clock or smartphone
If you use a medication planner (like a weekly pill box), double check your medicines so that you don’t make mistakes. Never move your medicines from your pill box back into the prescription bottle (they can be easily mixed up). Keep your pill box away from children or pets.

Long-acting opioids are taken on a schedule. Here's some advice about timing your doses:

You should take your medicine three times per day. This DOES NOT mean to take it at breakfast, lunch and dinner. To be safe, you need to space each dose out by 8-hours. (Meals are only 4-6 hours apart).

Here are some schedules that work for every 8-hour dosing:

8AM, 4PM, midnight
7AM, 3PM, and 11PM
6AM, 2PM, and 10PM

If an 8-hour schedule is too hard, it may be safe to take your morning dose up to an hour late, or your evening dose an hour early. Talk to your care team if every 8-hour dosing does not work for your daily life.

Patch long-acting opioids

Fentanyl (Duragesic) patch

Fentanyl patches are changed every few days. Look at your prescription box to see if you are supposed to change the patch every 48 hours or every 72 hours:

Here are some important tips for using fentanyl patches:

Choose a regular time of day to change your patch (for example, in the morning after waking up)
Write the dates on a calendar, or use this app to remind you when to change your patch
Write the date on your patch (a sharpie works best) whenever you put on a new one. This will help you remember when to change it.

Learning how to properly place and change your fentanyl patch can take time to figure out. Read more here: