Before considering a strong opioid

• Opioids are very good analgesics for acute pain and for pain at the end of life but there is little evidence they are helpful for long term pain: a small proportion of patients may benefit if dose is kept low and use intermittent, but identifying these patients is difficult.
• Inform patients of potential adverse effects from opioids. Click here for patient information.
• Opioid toxicity is more likely with increasing age, co-prescribing and co-morbidity: increased risk of falls. Monitor for side effects and reduce dose.
• DVLA: Patients have a responsibility to determine if their driving is impaired by medication and must inform the DVLA.
• Opioids prescribed on hospital discharge should not be routinely added to repeat medication. Limit quantities and keep under review.