Opioid prescribing for chronic pain

Opioids are very good analgesics for acute pain and pain at the end of life but there is little evidence that they are helpful for long-term pain. Despite this, they are widely prescribed for this reason – opioid prescribing more than doubled in the period 1998 to 2018. This has been referred to as an opioid epidemic in the UK, similar but not at the same scale as the opioid crisis in the USA, Australia, or Canada.

The harms of this prescribing are now better understood, and government is regulating further. The Health Secretary has asked the Medicines Regulator, the MHRA to explore the possibility of ensuring that packs of opioid medication carry clear warnings about the risks of addiction and dependence.

Doctors that specialise in pain have observed that over time the principles used in prescribing for acute pain and pain at the end of life have been applied to the field of chronic pain, despite a lack of evidence of effectiveness and the potential for harm.

There is no guidance from NICE that states that strong opioid are effective for chronic pain, and guidance from the Royal College of Anaesthetists (the professional body for doctors that specialise in pain) has been clear about the harm that can be caused.

Patient stories

We have produced two patient videos that aim to describe the harms of strong opioid prescribing in chronic pain.

Faye’s story

Faye’s story puts these potential dangers into reality by describing, from her parent’s perspective, the sequence of events that ultimately led to her untimely death from respiratory depression.

Sean’s story

Sean’s story describes how strong opioid prescribing had a devastating impact on his quality of life, and how he has engaged with more effective non-drug therapy that has been life-changing.

Video for prescribers

Video for patients

Resources

National guidance and resources for clinicians and patients

Royal College of Anaesthetists, Faculty of Pain Medicine: Opioids Aware

Live Well With Pain

We are pleased to see that in the South West of England there is a great deal of good work ongoing to review patients prescribed high dose opioids and we are signposting to this here.

Multimedia resources for patients, and prescribers

Cornwall & Isles of Scilly STP – Chronic Pain in Cornwall

Guidance

Bristol, North Somerset, and South Gloucestershire STP – Pharmacological Treatment of Adult Chronic (Non-Cancer) Pain

Devon STP – Management of Opioids

Dorset ICS – Dorset Opioid Prescribing for Chronic Pain: Resource Pack

Gloucestershire ICS – the Living Well with Pain Programme

Bath, Swindon & Wiltshire STP – Pain Management Guidance

Somerset STP – Analgesics

 

Other educational resources are also available and may be free of charge via your CCG Medicines Optimisation team:

PrescQIPP CIC – Reducing Opioid Prescribing in Chronic Pain