Opioids Aware: a general practice audit of high-dose opioid prescribing NHS England Midlands and East

Introduction

There has been a marked increase in the number of patients in the UK taking opioids from 2.5% in 2000 to 5% in 2015.¹ More patients are taking opioids at higher doses for chronic pain,^2,3 for which there is limited evidence of effectiveness.

A public facing⁴ audit with educational resources of high-dose opioids (≥120 mg oral morphine equivalent [OME]) prescribed for chronic pain was carried out in 74 general practices in the East of England, representing 663 418 patients.

The dose of ≥120 mg OME was chosen as doses above this are not associated with increased benefit but are associated with increased harms.²

The aim of this study was to quantify:

• the prevalence of high-dose (≥120 mg OME per day) opioid prescribing for chronic pain in general practices in the East of England;

• markers of prescribing quality (clear dose and frequency; clear indication; and review within the last 3 months);

• evidence of possible misuse or overuse; and

• co-prescribing of other potentially dependence-forming medications (DFMs)¹ (such as, benzodiazepines, z drugs, gabapentin, and pregabalin).

This study also aimed to record practice reflections and plans on their results.