1. Opioids Aware
A resource for patients and healthcare professionals to support prescribing of opioid medicines for pain

2. Effectiveness
Opioids are very good analgesics for acute pain and for pain at the end of life but there is little evidence that they are helpful for long-term pain
No study of opioid therapy versus placebo, no opioid therapy, or non-opioid therapy evaluated long-term (>1 year) outcomes related to pain, function, or quality of life.
Kalso E et al. Pain 2004; 112: Chou R et al. Ann Intern Med 2015; 162: 276.

3. Side effects

4. Increased risk of: Sexual dysfunction [OR 1.45 (CI -1.87)]
23/05/2018
Increased risk of:
Sexual dysfunction [OR 1.45 (CI -1.87)]
Fractures [OR 1.27 (CI )]
Myocardial infarction [OR 1.28 (CI )]
Abuse [wide range – up to 37%]
Overdose [HR 5.2 (CI )]
Motor vehicle accident [OR ]
Chou R et al. Ann Intern Med 2015; 162: 276.

5. http://www. dailymail. co

6. More common in younger ages
Overall, 5.4 % of adults aged 16 to 59 years had misused a prescription-only painkiller not prescribed to them
More common in younger ages
7.2 % of 16 to 24 year olds had misused a prescription-only painkiller in the last year, while 4.9 % of 25 to 59 year olds had done so
Less likely to have used other drugs
25% of the 16 to 59 year olds who had reported misuse of prescription-only painkillers reported having taken another drug in the last year
Whereas users of new psychoactive substances of whom more than 83% had used another illicit drug in the last year
Drug Misuse: Findings from the 2014/15 Crime Survey for England and Wales.

7. 23/05/2018
Drug Misuse: Findings from the 2014/15 Crime Survey for England and Wales.

8. High opioid doses and deaths
23/05/2018
High opioid doses and deaths ** ** ns
Paulozzi et al. Pain Med 2012.
Dunn et al. Ann Int Med 2010. ** ** ** ** ** ns **
Gomes et al. Arch Int Med 2011.
Bohnert et al. JAMA 2011.

9. Background
In 2015, million prescriptions were dispensed in England costing £ million
Items
Cost
BNF classification (opioid analgesics)
Compiled from Prescription Cost Analysis. Health and Social Care Information Centre.

10. Number of patients prescribed opioids
Zin C et al. Eur J Pain 2014; 18: 1343 – 1351.

11. Risks of running into problems with prescription opioids
Patient factors
Depression/common mental health diagnoses
Alcohol misuse/non-opioid drug misuse
Opioid misuse
Drug factors
High doses
Multiple opioids
More potent drugs
Concurrent benzodiazepines/sedative drugs

12. Who gets long term opioid therapy? Increased risk includes:
Patient factors
Depression/common mental health diagnoses (x3-4)
Alcohol misuse/non-opioid drug misuse (x4-5)
Opioid misuse (x5-10)
At risk patients are more likely to receive
High doses
Multiple opioids
More potent drugs
Concurrent benzodiazepines/sedative drugs

14. Who is OPIOIDS AWARE for?
Anyone involved in recommendation, prescribing, administration, dispensing of opioids
Different uses
Pain medicine specialist GP
Community pharmacist
Nurses and other HCPs

15. Contributors

16. OPIOIDS AWARE Apply best professional practice
Assess the condition, the patient and their context
Understand the clinical use of the drug
A structured approach to opioid prescribing
Information for patients

17. Best professional practice
Good Practice in Prescribing
Opioids and the Law
The legislation
The role of the Controlled Drugs Accountable Officer
Opioids and driving
Writing Opioid Prescriptions
Record Keeping
Improving Patient Safety and Minimising Harms
Reporting Adverse Effects About Medicines
Non-Medical Prescribing
Role of Pharmacists in Supporting Safe Opioid Prescribing

18. Assess the the condition, the patient and their context
About Pain
Particular Challenges of Long Term Pain Management
Assessment of Long-Term Pain
The Role of Medicines in Pain Management
A Stepped Approach to Pain Prescribing
Consideration of Patient Context when Prescribing

19. Clinical use of opioids
Opioids and Acute Pain Management
Opioids for Pain Management in Palliative Care
Opioids for Long Term Pain
Effectiveness of opioids for long term pain
Common Opioid Side Effects
Incidence
Management
Cost
Long term harms of opioid therapy
Fractures and falls
Endocrine system
Immune system
Opioid induced hyperalgesia

20. Clinical use of opioids
Dependence on and Addiction to Opioids
Prevalence
Terminology
Diagnosis of dependence
At-risk groups
Preventative measures
Identification and treatment of prescription opioid dependent patients
Current UK Data on the Misuse of Prescription Opioids
Office for National Statistics Data (ONS)
Crime Survey for England and Wales
National Drug Treatment Monitoring System (NDTMS)

21. A structured approach to opioid prescribing
Patient Assessment
Type of Pain and Opioid Therapy
Timing of Opioid Therapy
The Opioid Trial
Long Term Prescribing
Repeat Prescribing
Tapering and Stopping
Dose Equivalent and Changing Opioids
Checklist for Prescribers Initiating Opioid Treatment
Prescribing for Patients with a History of Substance Misuse
Acute Pain Management
Chronic Pain Management
Palliative Care

22. Information for patients

23. Opioid five-a-day

24. BE OPIOIDS AWARE