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You are here: Home / Resources / SystmOne Resource Centre / Medicine Management / Safe Prescribing of Opioids/ Opiates

Safe Prescribing of Opioids/ Opiates

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 ReturnedAction 
? Opioids 1.1 Likely to be on >100mg morphine equivalentPatients 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 equivalentPatients that are likely to be medication with a morphine equivalent dose of >=50mgReview patients and consider dose reduction. 
? Opioids 1.3 Any high strength opiatePatients receiving high strength opioids such as morphine, buprenorphine and fentanyl Review patients and consider dose reduction. 
? Opioids 1.4 Any instant release opiatePatients 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 OpioidPatients receiving any opioid Review patients and consider dose reduction. 
? Opioids 1.51 Opioid / other analgesic combination products – should be avoidedPatients 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 avoidedPatients 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 substitutionPatients likely to be receiving opioid substitution For reference. Consider review. 
? Opioid 2.1 Any opioid on repeat – not issued in the last 6 monthsPatients 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 monthsPatients 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: 

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