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.
Reports
Patient Identification
The following searches are available in the CDRC Quality > Pain folder
All searches in the 1.x group exclude people on the palliative care register or taking methadone.
All the searches 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 >50mg morphine equivalent | Patients that are likely to be medication with a morphine equivalent dose of >=50mg | Review patients and consider dose reduction. |
| ? Opioids 1.3 Any high strength opiate | Patients receiving high strength opioids such as morphine, buprenorphine and fentanyl | Review patients and consider dose reduction. |
| ? Opioids 1.4 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 1.5 Any Opioid | Patients receiving any opioid | Review patients and consider dose reduction. |
| ? Opioids 1.51 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 1.52 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 1.53 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 1.6 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
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:
