12 ways to reduce opioid prescribing

Try limiting supply to three days and avoiding fentanyl patches
number 12

The RACGP has released 12 points aimed at reducing opioid prescribing.

Advice includes limiting prescriptions to three days' supply for severe acute pain and avoiding fentanyl patches for non-cancer pain.

These are the points:

For acute pain

  • Know when non-opioid analgesics are preferred for acute pain in general practice, for example, headache, dysmenorrhoea, dental pains and minor musculoskeletal strains/sprains.
  • Engage a physio early in more severe acute musculoskeletal injuries. 
  • Prioritise non-opioid options for people who have been on long-term low-dose codeine preparations.
  • If opioids are necessary for severe acute pain, limit prescription to three days' supply.
  • On discharge from hospital, discuss early tapering of opioids as part of the recovery process.

For chronic non-cancer pain:

  • Maximise non-opioid therapies and multidisciplinary care in chronic pain.
  • Avoid opioids in patients with an active or past substance use disorder or unstable psychiatric disorder.
  • Where opioid therapy is necessary, ascertain responsiveness below 50mg morphine-equivalent dose a day, and seek assistance well before 100mg morphine-equivalent dose a day is reached.
  • Reassess opioid responsiveness regularly and often; have an agreed practice system for the 12-month structured review of opioid therapy.
  • Undertake intermittent planned reductions of opioid dose in chronic non-cancer pain management.
  • Avoid fentanyl patches for non-cancer pain.
  • Where patients are on more than a 100mg morphine-equivalent dose a day for chronic non-cancer pain, trial tapering this dose to more appropriate levels.