Medicines

Reducing or safely ending reliance on pain medicines is often a major milestone in a person’s self care journey. Your role in supporting this is crucial. These resources will help you guide your patient whether initiating, tapering or stopping opioid medicines.

Medicines

Opioids and the risk of addiction

Produced by the Medicine and Healthcare products Regulatory Agency (MHRA), an executive agency of the Department of Health and Social Care. It should be used as part of a discussion of the risks with a patients, who should be encouraged to share it with family, friends or carers, as they can all play an important role in the safe use of these medicines and in reducing the risk of harm.

Download the leaflet
Somerset CCG Pain Management site

Newly developed website from Somerset, which includes lots of resources aimed at improving knowledge for practitioners, practise resources and examples for supporting tapering.

Somerset CCG Pain Management site
Resources for GPs on opioids and chronic pain

Although patients are now unlikely to be started on opioids for chronic pain, there is a large group of patients who have been established on long-term opioids, but who may struggle to reduce and stop their opioids. These patients are unlikely to be deriving any benefit from the opioids but are exposed to significant harm, with some on extremely high doses. Oxford University Hospitals NHS Foundation Trust has put together useful guidance for GPs to help manage these patients together with an opioid calculator.

Resources for GPs on opioids and chronic pain
Opioids Aware

Information from Opioids Aware to support a safe and effective prescribing decision.
Good practice in prescribing opioid medicines for pain should reflect fundamental principles in prescribing generally. The decision to prescribe is underpinned by applying best professional practice; understanding the condition, the patient and their context and understanding the clinical use of the drug. Initiating, tapering or stopping opioid medicines should be managed in agreement with the patient and all members of their healthcare team. This resource, developed by UK healthcare professionals and policymakers, provides the information to support a safe and effective prescribing decision. Developed by The Royal College of Anaesthetists Faculty of Pain Medicine, 2017

Opioids Aware
Opioid medicines and the risk of addiction

Safety leaflet to help support patients in using opioid medicines safely. Produced by the Medicines and healthcare products Regulatory Agency

Opioid medicines and the risk of addiction
Patient stories: the harms of opioid prescribing

Guidance from NICE is clear that opioids are 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 that can be caused. NHS England has produced two videos that illustrate 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 parents' 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.

Patient stories: the harms of opioid prescribing
Opioid Tapering

Information for patients. Developed by National Pain Centre, McMaster University, Canada, 2017

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The Great Opioid Side Effect Lottery

Often, patients being prescribed opioids for their persistent pain do not know how little benefit they offer over the long term, or how prevalent and varied are the side effects people experience. This A4 sheet, designed to be used by clinicians in their consultations with patients, is a simple way to raise the question of benefits versus side effects. Using a ‘lottery scratch card’ metaphor, the sheet explains that opioids only actually reduce pain for around 10% of people in the long term, and their side effects can be both wide ranging and serious. It lists many of the side effects, and provides a number of statistics to show how common these side effects are. Working through the list with your patient, ask them to tick those side effects they are experiencing, as a starting point for introducing the idea of a medicines review.

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Pain management after surgery

A widely endorsed leaflet developed by the British Pain Society and its partners. Includes a useful timeline to be completed by the clinical team, showing the patient how soon they need to taper and stop medicines in order to avoid possible dependency.

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Opioids and Driving

Information for patients from Opioids Aware. Developed by The Royal College of Anaesthetists Faculty of Pain Medicine, 2016

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Taking Opioids for Pain

A patient information leaflet from Opioids Aware. Developed by The Royal College of Anaesthetists Faculty of Pain Medicine, 2016

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Ten Opioid Safety Messages

A patient information leaflet. Developed by West Suffolk Community Pain Management Service, 2016

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Person Centred Management of Chronic Non Cancer Pain

A tool designed to help family physicians and nurse practitioners develop and implement a management plan for adult patients with Chronic Non Cancer Pain in the primary care setting. With clear information on non-pharmacological treatments, non-opioid medications and opioids prescribing. Developed by Centre for Effective Practice, Canada, 2017

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Opioid Manager

These charts for clinicians to support effective, safe prescribing and management of opioids for people with chronic non-cancer pain. Developed by National Pain Centre, McMaster University, Canada, 2017

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Opioid equivalence, risks and recommendations

How much opioid is the person taking? A valuable guide to dosing based on oral morphine equivalent dose/day to enable safe prescribing. Developed by WSCCG Medicines Management Team and West Suffolk Integrated Pain Management Service, 2018

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Pain and pain prescribing: what is in a number?

Live Well with Pain is very pleased to be hosting this key paper by Cathy Stannard, the UK’s leading pain medicine specialist, from Gloucester CCG, published in the British Journal of Anaesthesia.

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Driving and Pain

Information for patients on driving whilst taking medications prescribed for pain.

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Medicines Decision Guide

A simple decision guide for patients to self complete and share with their reviewing clinician.

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