High Dose Opiate Policy Posted or Updated on 13 Dec 2023

Opioid de-prescribing policy in chronic pain.

Many patients require strong, potentially addictive medication to help manage their pain condition(s). Of concern are the opioid medications which can cause dependence and addiction, particularly when these are prescribed on a long term basis. Evidence has shown that these medications (e.g. codeine, tramadol, morphine, oxycodone) have very little benefit in the management of chronic pain conditions and often the risks associated with these medications outweigh any potential benefit.

New patients to the practice (along with existing patients) will be worked with to reduce the amount of opiates that they are prescribed this is due to the long term risks of these medications, particularly addiction and tolerance to these medications

As such the practice has the following policies regarding the issuing and ongoing prescribing of opiate medications.

OPIOID PRESCRIPTIONS

• Opioid prescriptions will not usually be added to your repeat medication list.
• A maximum of a months prescription supply will be issued at a time.
• Lost prescription or medication requested early will only be issued in exceptional circumstances.
• All opioid prescriptions will include full directions wherever possible and use of ‘as directed’ directions will be avoided.
• Opioid medication (e.g. codeine, tramadol, morphine, buprenorphine, fentanyl, oxycodone) will not be initiated for chronic primary pain, unless there are other underlying conditions that warrant the use of these medications.
• Co-codamol will be stopped in patients. This will be replaced with codeine only tablets. In this form it will give greater flexibility with dosing as codeine on its own is available in various doses. We will be weaning people off the codeine and stopping gradually. Patients can purchase the paracetamol separately to take with the codeine if they wish.

REVIEW OF OPIOID PRESCRIPTIONS

We know there are patients who have been taking these medications for a number of years. We will need to review these patients and discuss slowly weaning off their opioid medication. This will be done either with their usual doctor or with our in-house pharmacist.

We appreciate that for a patient who has been taking opioids for a number of years, there may be a sense that they won’t be able to cope without them. Evidence does show that we can reduce withdrawal symptoms by reducing the dose of the opioid medication slowly. The reduction schedule would be individualised for each patient.  

• All patients newly initiated on tramadol or morphine based medicines will be reviewed within 4 weeks of initiation, pain assessed and a decision made as to the effectiveness of the drug.
• New patients to the practice on long term opiates will be reviewed by a Clinician to discuss slowly weaning off their opioid medication. Treatment will only be continued where there is clear on-going evidence of benefit.
• Patients on long-term opioids will be reviewed every 6 months to discuss slowly weaning off their opioid medication. Treatment will only be continued where there is clear on-going evidence of benefit.
• Where opioids are ineffective, they will be stopped, even if no alternative is available.
• Wherever possible, patients will see the same prescriber for review of their opioid prescription.

The ‘My Live Well With Pain’ website (https://my.livewellwithpain.co.uk) has a range of useful resources to help you learn the skills you need to become an effective self-manager of your pain. If you have any concerns or would like to discuss your conditions/medications, please do speak to your usual doctor or our pharmacist.

The Partners

Crown Medical Centre

(Dec 2023)