Strong Opioids for Chronic Pain: Primary Care Update
Prescribing of strong opioids (morphine, oxycodone, fentanyl, tapentadol, and hydromorphone) across Scotland and within NHSGGC has reduced over the last few years following the publication of "Quality Prescribing for Chronic Pain- A guide for improvement" (Scottish Government and NHS Scotland, January 2018). The aim was to promote quality improvement in the prescribing of analgesic medicines in conjunction with non-pharmacological therapeutic approaches to manage chronic pain.
Background
- There is growing concern about the rise of prescribed opioid use for chronic pain, both in the UK and internationally, due to risk of dependence and very limited evidence for their effectiveness in long term pain conditions
- Within NHSGGC, the overall aim is to reduce the numbers of patients prescribed long term opioids, to ensure that they are being prescribed mindfully, safely and appropriately and in line with the NHSGGC Pain Management Guidelines
Key messages
- Practices should apply a consistent policy for prescribing opioids in order to reduce initiation and long term prescribing. Non-pharmacological approaches should always be considered
- Complete pain relief is rarely achieved with opioids and a realistic aim should be 30% improvement in pain and/or a significant improvement in functional ability
- Opioids are not effective in every patient and this should be discussed prior to commencing treatment. Consider initiating an ‘opioid contract’ between clinician and patient when first prescribing opioid therapy
- It is recommended that prescribers review patients to assess symptoms and ongoing benefit/need for therapy, with consideration of trial discontinuation if appropriate
NHSGGC Prescribing Initiative
A prescribing initiative “Review of Long Term Prescribing of Strong Opioids” was undertaken across NHSGGC in 2018-2019. This involved a peer education session within GP practices and review of patients who had been prescribed strong opioids for over 2 years. The aim was to encourage prescribers to be mindful in opioid prescribing, and practices to have an aspirational 10% reduction in the number of patients prescribed strong opioids long term. Please note this initiative focusses on chronic pain only.
Outcome
Since the NHSGGC Pain prescribing initiative was introduced in April 2018 that included pharmacist facilitated GP educational peer sessions:
- Both the numbers of new patients initiated on strong opioids and the total number of patients prescribed strong opioids have reduced
- NHSGGC is currently the third lowest mainland Board prescribing strong opioids in Scotland
- All NHSGGC HSCPs have reduced their volume of prescribing, as measured by Daily Defined Doses (DDDs)
- The numbers of patients prescribed strong opioids for more than two years have reduced across NHSGGC
Further information available:
NHSGGC Chronic Non-Malignant Pain Opioid Guideline
NHSGGC Chronic Non-Malignant Pain – Neuropathic Pain Guideline
NHSGGC Chronic Pain Management in Primary Care
www.paindata.org
http://www.therapeutics.scot.nhs.uk/pain/
Opioid medicines and the risk of addiction (MHRA Safety Leaflet)
Published 04/08/2021. Links updated 16/03/2022 and again 01/05/24
Medicines Update blogs are correct at the time of publication.