Opioids, encompassing both natural opiates and synthetic derivatives, are pivotal in pain management, anaesthesia, and palliative care. Acting on opioid receptors, particularly μ and κ, they modulate nociceptive pathways, effectively reducing pain perception. They are vital in the management of acute and post-operative pain in the urological setting. Prescribers should have awareness of the common side effects, signs of overdose and longer-term risks of dependency.