Harm caused by Opioid medication is a major cause for concern. NICE guidance recommends that Opioids are unlikely to be suitable for controlling primary chronic pain. A series of resources are available to help support harm reduction.
Patient Identification Reports
The following searches are available in the CDRC Quality > Pain folder
Searches ? Opioids 1.1 – 1.6 exclude patients on the palliative care register or taking methadone.
Searches ? Opioids 1.1 – 1.7 detect medication on repeat or being issued repeatedly over the past 3 months.
Tackling opioid use can feel like an overwhelming issue. The searches are designed to help divide this work into manageable chunks, starting with the highest risk patients.
| Search | Patient’s Returned | Action |
| ? Opioids 1.1 Likely to be on >100mg morphine equivalent | Patients that are likely to be medication with a morphine equivalent dose of >=100mg | Review patients. Patients requiring >100mg are unlikely to have an opioid responsive pain. Some guidelines recommended reduction and cessation of opioids |
| ? Opioids 1.2 Likely to be on >80mg morphine equivalent | Patients that are likely to be medication with a morphine equivalent dose of >=80mg | Review patients and consider dose reduction. |
| ? Opioids 1.21 Likely to be on >80mg morphine equivalent (not >100mg morphine equivalent) | Patients that are likely to be medication with a morphine equivalent dose of >=80mg, not including patients with a morphine equivalent dose of >=100mg | |
| ? Opioids 1.3 Likely to be on >50mg morphine equivalent | Patients that are likely to be medication with a morphine equivalent dose of >=50mg | Review patients and consider dose reduction. |
| ? Opioids 1.4 Any high strength opiate | Patients receiving high strength opioids such as morphine, buprenorphine and fentanyl | Review patients and consider dose reduction. |
| ? Opioids 1.5 Any instant release opiate | Patients receiving instant release opioids such as oramorph or oxynorm | Guidelines suggest that instant release opioids are unlikely to be suitable for chronic pain. Review patient and consider reduction or cessation |
| ? Opioids 1.6 Any Opioid | Patients receiving any opioid | Review patients and consider dose reduction. |
| ? Opioids 1.61 Opioid / other analgesic combination products – should be avoided | Patients receiving combination products such as co-cocodamol or codydramol. | These products are considered to be less suitable. Review patient and consider reduction, cessation or switching to separate medications. |
| ? Opioid 1.62 Codeine 30mg – consider reduction to 15mg | Patients receiving codeine 30mg tablets | Patients could be offered 15mg tablets instead to allow them to take smaller doses. |
| ? Opioid 1.63 Dihydrocodeine – should be avoided | Patients receiving dihydrocodeine | Some areas have indicated that this drug is no longer suitable for prescribing. Review patients and consider reduction/cessation |
| ? Opioid 1.7 Methadone or possible opioid substitution | Patients likely to be receiving opioid substitution | For reference. Consider review. |
| ? Opioid 2.1 Any opioid on repeat – not issued in the last 6 months | Patients with opioid on repeat which have not been issued in the last 6 months | Consider removing from repeat prescription |
| ? Opioid 2.2 Any opioid on repeat – not issued in the last 3 months | Patients with opioid on repeat which have not been issued in the last 3 months | Consider removing from repeat prescription |
| ? Opioid 3.1 Opioids and Benzodiazepines MHRA warning ? Opioid 3.11 Opioids and Benzodiazepines MHRA warning (not palliative care) | Patients receiving opioids and benzodiazepines MHRA warning (additional search to exclude palliative care patients) | This high risk combination has a high risk of respiratory depression and review/reduction/cessation should be considered |
| ? Opioid 3.2 Oxycodone and TCA – Coroner’s warning ? Opioid 3.21 Oxycodone and TCA – Coroner’s warning (not palliative care) | Patients receiving oxycodone and tricyclic antidepressants coroner’s warning (additional search to exclude palliative care patients) | This high risk combination has a high risk of respiratory depression and review/reduction/cessation should be considered |
Performance Monitoring Reports
The following searches can be helpful and can be found in the CDRC Performance > Pain folder:
Searches 1.0x exclude palliative care patients and patient on methadone.
| Search | Patients |
| 1.01-1.04 | Patients with opiates on repeat prescription or regular scripts in the past 3 months |
| 1.1 | Annual trend in opioid prescribing – number of patients who received at least one script in that financial year |
| 1.2 | As for 1.1 but limited to strong opioids |
| 2.1-2.5 | Current opioid prescribing split by deprivation (if IMD searches set for your area) |
Additional performance data can be found at Home | OpenPrescribing in the Opioid section, with these three charts likely to be the most useful:
NIPP Project Study Guidance
The searches required for this project are available to all units that are a member of the DCS group on SystmOne. If you are not a member of the DCS group, click here for a step-by-step access guide.
CDRC has created several searches to identify and prioritise patients currently taking opioid medication to potentially reduce their opioid dosage or to substitute their opioid medication for a safer alternative. Not all of these searches are applicable to the NHS Insights Prioritisation Programme (NIPP) opioid study.
For the NIPP Project, a member of staff at your SystmOne practice will run and report on the following searches:
- ? Opioids 1.1 Likely to be on >100mg morphine equivalent
- ? Opioids 1.21 Likely to be on >80mg morphine equivalent (not >100mg morphine equivalent)
- ? Opioids 1.6 Any Opioid
These searches are found in the CDRC Quality > Pain folder and are highlighted below:
NIPP Study Criteria:
Patients targeted will include adults (aged 18 or over) registered with a mobile phone number at practices and those regularly taking opioids for more than 90 days and at dose equivalent to ≥ 90 mg equivalent of morphine a day (this varies for each opioid medication) using electronic records. Patients will be excluded if they are coded cancer or palliative care. Eligible patients will be screened and identified by primary care staff in the participating practices.
Please note:
- The highlighted searches above exclude patients on palliative care, or taking Methadone/Subutex.
- These searches include opioids on repeat prescription or >=2 scripts in the last 3 months as a proxy for usage over 90d.
- The opioid drug combination required to meet the >90mg morphine equivalence is very rare, thus CDRC has created searches ? Opioids 1.1 and ? Opioids 1.2/1.21 to reflect the inclusion criteria as closely as possible.