1. Opioids Aware A resource for patients and HCPs to support prescribing of opioid medicines for pain
Sue Mulvenna CDAO NHSE S SW March 2016

2. Opioids Aware Faculty of Pain Medicine website
Public Health England funded
Supported by CQC and NHS England
Assistance requested from CD LINs to support dissemination and implementation of advice

3. Background
Community prescribing of opioids has more than doubled in last 10 years
10% of patients on long term opioids are prescribed potentially hazardous doses
Chronic opioid use is associated with reduced quality of life and increased mortality
50 – 80% of patients experience side effects
8 – 12% of long term opioid users meet criteria for addiction

4. Five main points
Opioids are good analgesics for acute and EOLC but not usually helpful for long term pain
A few patients may benefit from intermittent low dose opioids long term
The risk of harm increases above a dose greater than 120mg morphine (or equivalent) daily, with no increased benefit
If a patient on opioids is still in pain, they should be discontinued – even if no other treatment is available
Chronic pain is very complex – once patients are on high dose of opioids and still have disabling symptoms, then a specialist assessment will be needed

5. Why does it go wrong so often?
Patient expectations not addressed and managed
The absence of a shared management plan with clear treatment goals
Repeat prescriptions and escalating strengths become the norm
Unclear who is in control, GP or patient
Failure to resolve tension between patient centred care and evidence based medicine

6. Avoiding new problems
Early recognition of at risk patients, with more structured management
Checking the patient’s expectations of opioid therapy and advising on the limited benefits
Avoiding prescribing opioids as a means of managing the therapeutic relationship

7. Managing patients already on opioids
Practice level reviews of all prescribing for chronic pain, to avoid negotiating on the hoof
Gaining agreement of shared aims within the GP team
Clear communications between the team and the patient
Clear boundaries must be set and maintained
GPs will need support for difficult cases from commissioned specialist services

8. Advice for prescribers
How to assess patients before starting opioids for chronic pain
How to initiate and manage a trial of opioids
Choice of opioid and formulation
Advice on changing opioids, if effective but with side effects
How to taper and stop opioid doses safely

9. Information for patients
About different types of pain
Things to think about when considering opioid therapy
FAQs about taking opioids
Advice about opioids and driving

10. Website address
For queries or concerns related to this presentation or general management of CD:
For help or advice about managing a patient’s opioid prescription: