Reducing long-term opioid use

Opioids, such as codeine, morphine, oxycodone and tramadol , can provide highly effective pain relief when used in the short-term. However, when used over longer periods they can lead to dependence, cause physical and mental health issues, or even death from accidental overdoses or heart conditions resulting from side effects.

Tony Jamieson, Clinical Improvement Lead for NHS England’s Medicines Safety Improvement Programme, explains: “While opioids are extremely useful for short-term pain relief, they can cause a range of problems. They cause excessive sleepiness and confusion or ‘brain fog’; they also reduce people’s ‘get-up-and-go’ instincts. They slow the bowels causing constipation and affecting digestion. They make breathing shallower and slower and unresponsive to increased oxygen requirements. They have negative effects on the immune system. And they also affect the body’s hormones and how they work to keep our body and mind in balance.”

Despite these health risks, long-term opioid use is common, with data from January 2021 showing that over 1 million people in England were prescribed opioids for more than three months. Through its Medicines Safety Improvement Programme, NHS England’s national patient safety team, in partnership with the Patient Safety Collaboratives across England, is supporting other NHS teams to work with patients to address this.

The programme reviews prescribing data to identify communities with the highest levels of long-term opioid use. It helps those areas with resources to support clinicians and patients to better understand the risks and make use of alternative pain management support and therapies.

Tony Jamieson explains: “We aim to help and support local teams to personalise care with patients to improve the use of opioids. We support NHS organisations to work with their local communities to hear ideas, share and spread successful initiatives, and work with partners, such as local authorities, to understand the effects our interventions are having.”

As a result, between January 2022 and March 2023, an average of 25,629 fewer people a month were prescribed opioids for periods longer than three months. This could mean as many as 414 fewer people who might die over the next two years from the wide-ranging side-effects opioids have on the body and mind. People have also reported better quality of life, less pain and less disability as a result of improved care. 

Paul Hemsil, a volunteer with Derbyshire Healthcare NHS Foundation Trust, involved with setting up a pilot scheme to help people reduce their use of prescription drugs safely, talks about his experience, after becoming addicted to painkillers following a back and neck injury 30 years ago:

“If I’d known when the GP handed me the prescription for oxycontin, if she’d said take that it’ll ruin your life, I would have said no thanks, I’ll find alternatives to manage my pain. I just wish that when I was first diagnosed with it years ago more could have been done…. then I probably wouldn’t be suffering the pain I’m suffering now.”

The work of the programme is continuing as we look to further support the NHS Integrated Care Boards to create personalised and innovative support for people who have been prescribed opioids and other medicines that can cause dependence.

The Medicines Safety Improvement Programme is part of the wider National Patient Safety Improvement Programmes, which are a key part of the NHS Patient Safety Strategy, to deliver safety and quality improvements across the NHS in England. The impact of these programmes play a major part in progress towards meeting the ambition of the NHS Patient Safety Strategy, to save an additional 1,000 lives and £100 million per year. Find out more on our NHS Patient Safety Strategy webpage.

Further information