Using our advice

This resource supports healthcare professionals in taking actions to promote the safer use of opioids for chronic, non-cancer pain. It aims to equip healthcare professionals with insights, support, and shared learning, to address practice with opioids that may lead to harm.

Patient harm

Opioids provide effective analgesia in acute pain and in end of life care, but are of limited use for treating chronic, non-cancer pain.

Long-term use of opioids can lead to a range of adverse effects, including:

• dependence
• endocrine abnormalities
• mental health issues
• opioid-induced hyperalgesia
• death

The NHS Medication Safety Improvement Programme (MedSIP) estimates that for every 62 individuals who stop opioids, 1 death is prevented.

Clinical use

The NICE guideline ‘Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain’ covers the management of chronic pain, including self-management.

The NICE guideline ‘Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults’ discusses initiation, monitoring and withdrawal of opioids.

The MHRA Drug Safety Update ‘Opioids: risk of dependence and addiction’ (2020) outlines the risks associated with opioids and provides advice for healthcare professionals (HCPs).

Opioid stewardship

Opioid stewardship consists of coordinated interventions to improve, monitor, and evaluate the use of opioids to support safe use.

Systemwide interventions are needed to support effective opioid stewardship. Large scale, sustained change can be made when healthcare providers work together.

Key strategies to improve opioid safety

A system wide approach is needed to reduce harms from opioids. Opioid prescribing is prevalent across all sectors, affecting a wide range of individuals. Individuals taking opioids engage with multiple HCPs and different care settings.

Given the scale of the issue, it may be useful to prioritise or focus on specific populations or settings when taking initial steps to address the challenges of opioid safety. Several strategies can be used to improve opioid safety. These may be used alone, or in combination with one another.

Although there is some overlap, there are alternative safety considerations for short-term use of opioids for treating acute pain which are not covered in this article.

Professional collaboration

A collaborative approach is essential for developing a strategy to promote safer practices with opioids. HCPs across all care settings, from a range of specialities, should be involved in the development and implementation of initiatives related to safe opioid use. Creating a core working group, including key stakeholders from across the system and a range of professional groups, supports a coordinated approach to improvement. Nominating a leadership team, with defined responsibilities, provides necessary oversight.

Examples of multi-disciplinary team (MDT) core members may include:

• healthcare professionals from primary care
• healthcare professionals from secondary care
• specialist pain teams
• substance misuse teams
• mental health practitioners
• physiotherapists
• social prescribers
• health coaches

Multi-disciplinary clinical review

MDT clinical reviews help ensure individuals, especially those on long-term or high-dose opioids, have appropriate clinical management plans.

Using a collaborative, multi-disciplinary approach to review opioid use strengthens opportunities for clinical interventions that may reduce or limit opioid use. This 15-minute video explores using cross system approaches to reduce harm from opioids, including how MDT meetings have been used to review patients on high-dose opioids.

The Specialist Pharmacy Service’s Social prescribing and pharmacy – an ‘on the couch’ conversation discusses social prescribing in more depth.

Communication at the care interface

When opioids are initiated, a clear treatment plan should be documented in healthcare notes and communications, for example discharge summaries. Clear documentation and communication of treatment plans, for example the intended stop date, helps to ensure opioids are reviewed and not continued inappropriately.

This 11-minute video discusses the Opioid Use Change (OUCh) Project which included an aim to increase opioid stop dates on discharge summaries.

Personalised care

Embedding NHS England’s personalised care approach  within practice promotes safer opioid use.

Patients’ perspectives and priorities should be understood and incorporated into action plans and interventions designed to improve opioid safety. These videos (6-minutes and 24-minutes) explore an individual’s experiences with opioids. 

Practical support for implementing a personalised care approach for individuals on long-term opioids is discussed in this 13-minute video.

Shared decision making

Taking actions to embed shared decision making into routine clinical practice is an intervention to support safer use of opioids.

Individuals should be given appropriate information on the risks and benefits of their medicines, and should be involved in prescribing and deprescribing decisions. NHS England’s shared decision making approach can help manage a person’s expectations about managing their condition.

NHS England offer guidance on optimising personalised care for adults prescribed medicines associated with dependence or withdrawal symptoms. This includes five actions to help systems develop plans to support individuals taking medicines associated with withdrawal symptoms. Action 1 is ‘personalised care and shared decision making’.

Supported self-management

HCPs should discuss self-management of chronic pain with individuals, and support them to self-manage their condition. NHS England provide information about supported self-management. Interventions can include self-management education, participation in peer support groups, and health coaching.

Upskilling healthcare professionals

HCPs should be equipped with the skills to promote safer use of opioids. Principles of safer use should be embedded within local and system wide training programmes.

The OUCh resource is freely available to all HCPs.

The Faculty of Pain Medicine of the Royal College of Anaesthetists’ Opioids Aware site has several useful resources for HCPs. These include a checklist for prescribers and information about stopping opioids.

Live Well With Pain’s training for practitioners offers training for social prescribers, clinicians and other practitioners in supporting pain self-management.

Patient engagement and education

HCPs should build trust and rapport with individuals who are on long-term opioids to support positive discussions about their conditions and goals of care.

Patient consultations

Sometimes having conversations about deprescribing can be difficult. This 32-minute video explores how to have positive and constructive consultations with individuals on long term opioids.

The Specialist Pharmacy Service’s webinar ‘Navigating difficult conversations with confidence’ discusses this in depth.

Informed patients

HCPs should ensure that individuals on opioids are fully informed about the available treatment options, and their benefits and risks. This should include providing written and verbal information.

Several organisations have resources to help individuals living with pain:

• the Faculty of Pain Medicine of the Royal College of Anaesthetists provides information for patients, including patient information leaflets about pain, and the use of opioids
• Live Well with Pain have resources and tools designed to help individuals live well despite persistent pain
• The British Pain Society have several patient publications, including a leaflet ’Managing pain after your surgery’ which includes information about weaning opioids after surgery and a pain management plan template

Standardised practice

Where possible, roles and responsibilities should be clear and understood across the system.

Clear policies, for example opioid tapering and post-operative analgesia guidelines, can help to ensure that opioids are reviewed, tapered and stopped within an appropriate timeframe.

Introducing an intervention

Undertaking a system mapping exercise prior to implementing an intervention will allow you to see where it sits within the already established system. It will also support identification of any possible unintended consequences that may arise as a result of the intervention. This 6-minute video explores using a system-wide approach to improve opioid safety.

Prior to implementing an intervention, decide which outcomes will be measured. This will support the analysis of the effectiveness of the intervention.

Shared good practice

Sharing experiences with improvement interventions can help to prevent duplication, support efficient use of resources and promote standardised practice across the NHS. Examples of exemplar practice, and a discussion board to network with peers, can be found on the MSATS FutureNHS workspace.

Full webinar recording

The SPS Medication Safety across the System series of webinars are interactive sessions aimed at healthcare professionals working in any sector with a role within or passion for medication safety.

The recording of the full MSATS: Opioid Safety webinar is available, this includes some of the presentations included during this page. Information presented during the webinar and associated videos was correct at time of recording. Current guidance should be followed.