Facts about Prescribing Opioids
As a medical health professional, patients look to you as a key influence in their pain management. The strategies you equip your patients with, and the medication you prescribe, should always be clinically appropriate and tailored to their personal needs. There are a number of tools and resources you can access to help maximise patient benefits and minimise the potential harms associated with prescription opioids.
Know the Risk – Daily Oral Morphine Equivalent
Patients can be on a combination of prescription opioids or at doses which place them at risk. The Faculty of Pain Medicine’s opioid calculator is an essential clinical tool, designed to simplify the calculation of equianalgesic dose by expressing it as total oral Morphine Equivalent Daily Dose (oMEDD). It uses a “traffic light” dose warning system as a clear, simple way to indicate the risk of dose-related harm.
HealthPathways SA is a free online portal that provides GPs and other health professionals with easy access to comprehensive, evidence-based assessment, management and local SA referral pathways for specific health conditions. HealthPathways SA is developed locally by South Australian GPs, specialists, nurses and other health professionals to improve patient access to the right care at the right time in the right place.
Pathways to support patient care include:
- Chronic Non-cancer Pain in Adults
- Medications in Chronic Non-cancer Pain
- Self-management Support for Chronic Pain
Prescribing In The Community
Most acute pain conditions presenting in general practice can be treated with non-opioid analgesia, with the RACGP specifically advising against prescription opioids for:¹
- Uncomplicated back and neck pain
- Uncomplicated musculoskeletal pain (i.e. shoulder pain)
- Uncomplicated headache or migraine
- Non-traumatic dental pain
- Acute exacerbation of chronic non-cancer pain (CNCP)
- Irritable bowel syndrome
If you do make the decision to prescribe opioids, this should be a conscious decision and made in partnership with the patient. Consideration should be made for the length of trial, discussion of potential side effects, additional supporting self-management strategies and review criteria. This is to reduce the risk of “drifting” into long-term opioid use, a common situation after an acute presentation or post-surgery.
To find out more on prescribing best practice, visit:
- The Royal Australian College of General Practitioners (RACGP) – guidelines for prescribing drugs of dependence
- Faculty of Pain Medicine ANZCA – recommendations regarding the use of Opioid Analgesics in patients with CNCP
- Faculty of Pain Medicine ANZCA – quick reference recommendations for conduct of an opioid trial in patients with CNCP
- The Routine Opioid Outcomes Monitoring (ROOM) Tool – a screening tool for prescription opioid dependence, developed specifically to use in primary care settings.² Download here.
Opioids and Their Impact on Surgery
Research is identifying the use of opioids pre-surgery, and the significant impacts on surgical outcomes it brings, including an association with increased postoperative complications.³ Reducing the use of opioids before surgery can result in improved clinical outcomes for your patients, comparable to those who use no opioids at all.⁴
The role of opioids in post-surgery management is also a focus in Australia. Recent research has identified in many Australian hospitals, prescription opioids are a standard discharge prescription post-surgery.⁵ In April 2019, the Lancet revealed a major contributor to the opioid issue is the inappropriate management of post-surgery pain that becomes chronic and long-lasting.⁶
For more information, explore the work being undertaken by Dr Jennifer Stevens, anaesthetist and pain specialist at St Vincent’s public and private hospitals in Sydney and acting chair of ScriptWise.
Patients With Long-Term Opioid Use
Prolonged use of opioids can result in physical side effects including but not limited to sedation, respiratory depression, dry mouth, constipation and sexual dysfunction. It can impact on the general safety of your patient and their personal wellbeing.
Often prescription opioids are playing a role in maintaining your patient’s wellbeing by assisting in masking distress. You can help your patient access support and identify what the underlying “life pain”. Be kind and set expectations.
NCETA have a short resource developed to address several key issues related to pharmaceutical opioids. It is available here.
 Royal Australian College of General Practitioners (2017), Prescribing drugs of dependence in general practice – Part C1: Opioids.
 Nielsen S, Picco L, Middleton M, Kowalski M & Bruno R, Validation of the Routine Opioid Outcome Monitoring (ROOM) Screening tool in patients prescribed opioids for chronic pain. National Institute on Drug Abuse (NIDA) International Forum, San Antonia, Texas, USA. June 17, 2019 (Poster presentation)
 Cozowicz C, et al. (2017), ‘Opioid prescription levels and postoperative outcomes in orthopaedic surgery’ in Pain, 158(12): 2422-2430.
 Nguyen LCL, et al. (2016), ‘Preoperative reduction of opioid use before total joint arthroscopy’ in Journal of Arthroplasty, 31(9): 282-287.
 The Society of Hospital Pharmacists of Australia (2018), Reducing opioid-related harm: a hospital pharmacy landscape paper.
 Monash University (2019), ‘Landmark Lancet series reveals poor management of surgery pain key contributor to global opioid crisis’.