Routes of opioid administration for pain management

The route of administration (eg oral, subcutaneous, intravenous, intranasal, transdermal) depends on multiple factors, including:

• the opioid—not all opioids can be administered via any route
• the clinical presentation (eg after significant trauma, patients may have impaired gastrointestinal absorption)¹
• the urgency of the presentation—parenteral opioids provide a faster onset of action compared to transdermal and oral administration
• the monitoring available—some routes of administration require frequent monitoring (based on their peak effect) and cannot be administered in all settings
• the facilities and staffing available—intravenous and intranasal opioids require appropriately trained staff and administration protocols.

Suitable routes of administration are discussed in the relevant clinical topics.

Administration of opioids by the intramuscular, sublingual, buccal, intrathecal or epidural route is not discussed in this guideline.