Greater Glasgow and Clyde Medicines

The NHSGGC Opioid Prescribing for Chronic Non Malignant Pain Guideline has been reviewed and updated.

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Guideline News March 2024 here

In January 2024, the MHRA issued an alert on regulatory action taken to update the indications for all systemic fluoroquinolones to state they should only be used when other commonly recommended antibiotics are inappropriate

• Many patients may need to use sharps, such as needles, syringes and fingertip lancing devices, to treat and manage their condition.

• Sharps should never be disposed of in domestic waste, recycling, or in a container that is no longer needed, such as a drinks can or a bottle. This is potentially hazardous to anyone who comes into contact with the waste, including refuse collectors and members of the public.

• To minimise the risk of needle stick injuries, a sharps bin, (e.g. SharpSafe® or Sharpsguard®) can be prescribed, which can be returned to the patient’s GP practice for safe disposal once full. GP practices can accept sharps containers independent of their source, however, sharps containers (with exception of needle exchange) should not be returned to community pharmacies.

Adrenal Crisis is a medical emergency and failure to recognise and treat promptly can be fatal.  In 2021 Health Improvement Scotland (HIS) issued an alert to highlight a new Steroid Emergency Card which supports timely recognition and treatment of potential adrenal crisis.

Key Messages

• A number of widely used drugs are known to have the potential to prolong the QTc interval
• Prescribers are advised to be aware of the QTc prolonging potential of medicines they prescribe, particularly to high-risk patients

Key messages

• Adrenal insufficiency (as highlighted in the NHSGGC Non-Malignant Pain Opioid guideline) is a possible side effect of long-term opioid prescribing.
• Despite the fact that opioids are clearly linked to various endocrinopathies, OIAI has not been well-researched and is thought to be largely under-recognised in practice.
• Routine testing is not recommended if the patient is well. However, if the patient has symptoms of adrenal insufficiency (e.g. fatigue, weight loss, low blood pressure, fainting, increased thirst, low mood) then an early morning cortisol test is recommended, with referral to endocrinology if cortisol is low
• OIAI has been reported with wide ranges in median duration of use, median morphine equivalent daily dose and estimated prevalence.
• As there is no specific dose or duration of treatment associated with the development of OIAI the risk is expected to be higher with the cumulative exposure to the opioid.

The supply of GLP-1 RAs continues to be limited, with supply not expected to return to normal until at least the end of 2024. The supply issues have been caused by an increase in demand for these products for licensed and off-label indications.