UK recommendations on opioid stewardship

Abstract

The effect of the prescription opioid crisis in North America is well documented. 1 In 2018 some 68 500 Americans died from opioid overdoses, and in 2015 the cost of opioid misuse to the US economy was estimated at $150bn (£110bn; €120bn). 1 The EU now has an estimated 1.3 million high-risk opioid users, 1 and 110 000 people worldwide died from opioid use disorders in 2017-77% more than in 2007. 2Opioids were prescribed to roughly 5% of the UK population in 2015. 3Between 1998 and 2016, opioid prescriptions increased by 34% in England, and the total oral morphine equivalence dose increased by 127% to 431 000 mg/1000 population/year. 4A recent UK study found that 14.6% of people given opioids for the first time became long term opioid users within a year. 5 response to this healthcare crisis, the UK Medicines and Healthcare Products Regulatory Agency (MHRA) has issued recommendations that before prescribing opioids, clinicians must discuss the risks and features of tolerance, dependence, and addiction with patients, and jointly agree a treatment strategy and plan for the end of treatment. 6These new recommendations have the potential to alter opioid prescribing habits substantially.The UK General Medical Council advises that clinicians should comply with MHRA recommendations along with other guidance, making compliance a professional duty. 7propriate prescribing of opioids should be a priority, focusing where possible on nonpharmacological strategies, including referral to wellbeing services, physiotherapy, exercise, and weight loss programmes, as well as alternative therapies such as mind-body therapy and acupuncture.

Topics & Concepts