Opiate and Morphine Prescribing in Non-Cancer Pain

Burdwood Surgery Policy for Opiate and Morphine Prescribing in Non-cancer Pain

There are widely reported safety concerns regarding overdose and misuse but also we are now aware of long-term risks including depression, fractures, depressed immunity and lowered pain threshold so we have reviewed our practice policy for long-term opiate and morphine prescriptions. Moreover, there is good evidence that higher doses give no additional pain relief.

1. Opioids that do not hold a UK licence for non-cancer pain.

Our surgery policy is not to prescribe opioid preparations that do not hold a U.K. licence for non-cancer pain. This includes where such preparations are initiated or supervised by pain management or other secondary care specialists, whether NHS or private.

This will apply to fentanyl lozenges, nose sprays, mouth wafers or tablets under the tongue or any opioids currently licensed for breakthrough pain in patients receiving opioid therapy for chronic cancer pain only.

2. Opioids that do have a U.K. licence for non-cancer pain.

Examples include oral morphine solution (Oramorph), morphine tablets (MST and Zomorph) and Fentanyl patches.

Fentanyl patches are licensed for chronic intractable non-cancer pain. However, their use is generally restricted to where there are problems with swallowing, bowel absorption of oral preparations or special case requiring supervised patch changes by a family member or carer. There are also safety issues, for example, risk of toxicity with variable absorption in hot weather and differences in effectiveness between patch types that may be an issue where there is as supply problem. Fatalities have occurred when patients have not taken an opiate before or not been previously treated with stronger opioids.

3. Long term repeat prescriptions for opiates.

Repeat prescriptions are checked by the prescribing clinician every 3 to 6 months depending on the case, either face-to-face or by reviewing the clinical record to assess the risk, preparation type, numbers of prescriptions issued and consider the potential for supervised gradual dose reduction and possible replacement with alternative pain-killers or non-drug interventions.

The above policy does not apply to patients who require opiates for cancer treatment.

Last updated October 2019.