Introduction and crucial aspects
Introduction
Despite the poor evidence for opioids providing long-lasting reduction in pain, the number of prescriptions for opioids to treat chronic pain is increasing.1
A study in 2020 found that 14.6 per cent of opioid naïve people became long-term users within a year of their first opioid prescription, highlighting the potential for dependence.2
Crucial aspects
In 2020, the UK Medicines and Healthcare products Regulatory Agency (MHRA) released a drug safety update on the risks of dependence and addiction associated with the use of opioids.
The update stated that before prescribing opioids, clinicians must discuss the risks and features of tolerance, dependence and addiction, and come to a shared decision about a treatment strategy and plans for discontinuing opioids.3 The Commission on Human Medicines (CHM) also recommends that transdermal fentanyl patches should not be used for non-cancer pain in people who are opioid naïve.3
The Institute for Safe Medication Practices (ISMP) defines opioid stewardship as “coordinated interventions designed to improve, monitor, and evaluate the use of opioids in order to support and protect human health”.4 A crucial aspect of opioid stewardship is the education of clinicians and people living with pain. Another key aspect is ensuring patient safety, such as a regular review of all patients on high-dos e opioids (equivalent to 120mg daily oral morphine or higher). This should result in a reduction of opioid misuse, problematic dependence and opioid-related adverse events.