The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications. Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely. To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Reducing opioid prescribing, can be viewed here. For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/

1. Reducing Opioid Prescribing
Sree Seelam
Potential Risks:
• Approximately 80% of individuals using opioids may encounter at least one adverse
effect, such as constipation, nausea, itching, dizziness, hospitalization, and even
death.
• Prescribed opioids are linked to heightened psychosocial issues, increased
hospitalization rates, and a rise in mortality.
• Opioid toxicity, characterized by sedation and slow respiration, becomes more
likely with advancing age, coexisting health conditions, concurrent medication use,
and when combined with alcohol or illicit substances.
• Opioids can exert prolonged endocrine and immunological effects, leading to
issues like reduced libido, depression, and increased susceptibility to infections.
• Abrupt cessation or reduction of opioid doses may lead to withdrawal symptoms,
including sweating, yawning, and abdominal cramps. Tramadol, even after a short
course, is associated with common withdrawal occurrences.
• Addiction is marked by impaired control, excessive use, cravings, and continued
usage despite resulting harm.
• Opioid-induced hyperalgesia is a phenomenon where pain becomes more
widespread and qualitatively different from pre-existing pain.
Despite these concerns, the importance of ensuring safe and effective prescribing practices
remains paramount, underscoring the ongoing priority of managing opioids for healthcare
providers. The approach to treating pain needs to be thoughtful and considerate, especially in the
context of chronic pain, which differs significantly from end-of-life care. The long-term certainty
surrounding the use of these drugs raises questions about their efficacy. Although opioids offer
valuable and effective pain relief in the short term for acute pain resulting from trauma, surgery, and
cancer, their safety and effectiveness for managing chronic non-cancer pain remain uncertain.
Issues such as tolerance, dependence, and addiction can arise, necessitating a careful weighing of
the benefits and drawbacks of long-term opioid use in the treatment of patients' pain.
What we agreed and implemented
1. Thorough evaluation holds significance; individuals with depression, anxiety, or other
psychiatric or psychological coexisting conditions require extra assistance and supervision
to prevent problematic drug usage. There exists substantial potential to minimize new
prescriptions and limit prescribing to specific patients. Exercise caution before deciding to
prescribe an opioid.
2. Establish therapy objectives prior to initiating an opioid trial; achieving total pain relief is
improbable, and treatment efficacy is evidenced by the patient gaining the ability to engage in
activities hindered by pain. Collaborate with the patient to set a trial duration and conduct
regular treatment assessments, particularly if any concerns arise.
3. Carefully assess requests for dose escalation. In the context of chronic pain, addressing
more challenging and intricate cases may necessitate additional time or specialized
intervention.
4. The effectiveness and potential side effects are comparable across all opioids, although
individual patients may exhibit better tolerance to one drug over another.
5. Time frame of prescribing opioid's documented in plan
6. New patients-don’t add to repeats if prescribed for acute pain from previous surgery
7. If repeats -not for longer than 3months
The COVID-19 pandemic has introduced challenges to our practices, leading to a significant shift towards virtual consultations. This transformation, combined with heightened levels of patient
anxiety, depression, and immobility, has created substantial hurdles in pain management. Consequently, there has been a notable increase in the prescription of opioids in general practice,
particularly for addressing the intricacies of chronic non-cancer pain. The growing body of evidence suggests that the potential risks associated with opioids in these cases may outweigh the
benefits, giving rise to concerns such as addiction, elevated hospitalization rates, and premature mortality.
References:
1. Opioids Aware. A resource for patients and healthcare professionals to support prescribing of opioid medicines for pain. The Faculty of Pain Medicine, Royal College of Anaesthetists. https://fpm.ac.uk/ opioids-aware
2. Clarke, H., Soneji, N., Ko, D.T., Yun, L. and Wijeysundera, D.N. 2014. Rates and risk factors for prolonged opioid use after major surgery: population based cohort study. BMJ, 348:g1251
3. Foy, R., Leaman, B., McCrorie, C., Petty, D., House, A., Bennett, M.I., Carder, P., Faulkner, S., Glidewell, L. and West, R. 2016. Prescribed opioids in primary care: cross sectional and longitudinal analyses of influence of patient and practice characteristics. BMJ
open, 6(5), p.e010276.