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 have been 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.

The harms of this prescribing is now better understood and government is regulating further.  The Medicines and Healthcare products Regulatory Agency ensures that packs of opioid medications carry clear warnings about the risks of addiction and dependency.

It has been 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 for effectiveness and the potential for harm

Guidance from NICE is clear that opioids and not indicated 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 it can cause.

The risk of harm increases substantially at higher doses and those patients that are prescribed other drugs such as benzodiazepines.  Patients coprescribed benzodiazepines and opioids are at increased risk of A&E visits, in patient hospital admissions and death.  This is not only due to overdose but all cause morbidity and mortality.

Due to this we will be reviewing all our patients co-prescribed these medications and discussing a personalised slow plan to try to deprescribe these medications.