Reducing harm for people with chronic pain by reducing the prescribing of opioids 2022/23

At the Health Innovation Network (HIN) we developed a local programme across south London in response to the nationally commissioned Medicines Safety Improvement programme (MedSIP). The ambition for 2022/23 was for Patient Safety Collaboratives (PSCs) working with a minimum of 15 ICS, will collectively achieve the following outcomes among adults living with chronic (non-cancer) pain by the end of March 2023:

• 30,000 fewer people were prescribed oral or transdermal opioids (of any dose) for more than 3 months.
• Of the 30,000 above 4,500 patients will have been prescribed a high dose (≥120mg day oral morphine equivalent) at baseline and have now stopped opioids.

Working with staff to drive improvement

We delivered a CPD-accredited Opioid Stewardship Quality Improvement Collaborative for clinicians across south London from October 2022 to March 2023. Please click here to find out more.

Using opioid prescribing data for system audit-feedback

We shared local opioid prescribing data packs with GP practices across south London based on the Campaign to Reduce Opioid Prescribing . Please click here to find out more.

Working in partnership with people living with chronic pain

We facilitated an experience-based co-design (EBCD) project using the Point of Care Foundation methodology. The aim of the EBCD project was to improve chronic pain management by bringing patients and staff lived and learnt experiences together to prioritise and co-design solutions as equal partners. Please click here to find out more.

Recommendations for whole systems working to improve opioid stewardship

1. Pain clinic referrals are often seen as the next step once other options have been explored in primary care however onward referral to for example talking therapies, physiotherapy and exercise should be considered.
2. Where possible it is important that the same clinician and prescriber who commence the opioid prescription are also responsible for ongoing monitoring and reviewing. Clinicians should have the opportunity to discuss complex cases at team meetings.
3. Primary and secondary care clinicians should have an awareness of the breadth of services in their locality that can assist with supporting patients to adjust to the impact of living with persistent pain on their daily life e.g., social prescribing link workers.
4. Joint consultations for complex pain management in adults across primary care networks e.g., clinic appointments with colleagues across several disciplines with specialist input from hospital pain clinics should be considered. GP appointments tend to be short, therefore making it challenging for clinicians to have sufficient time to support patients living with persistent pain as much as they would like to.
5. Maximising digital prescribing systems e.g., creating alerts, issuing weekly prescriptions, and communicating plans to reduce high-risk opioid prescribing to other multidisciplinary team colleagues.
6. Sharing decisions with patients about how to improve persistent pain management and agreeing on reductions when tapering opioids through regularly scheduled regular follow-ups.
7. Introducing the idea of changes to the ways persistent pain is managed and informing patients of the risk of harm for long-term and high-dose opioid prescribing at an initial appointment and scheduling follow-ups to explore alternatives to pain medicines.

You can read more about developments with our local programme throughout 2022/23 here in our blogs:

Medication Without Harm: Improving care for people living with chronic pain - Health Innovation Network

Medication Safety: How patients and healthcare professionals make safety work - Health Innovation Network

Working with patients as equal partners to improve chronic pain management - Health Innovation Network