The problem with opioids....
Opioids are classed as high-risk drugs because they have the potential to cause addiction and serious, life-threatening harm if misused, prescribed inappropriately or administered incorrectly (Institute for Safe Medication Practices, 2014).
Control of opioids
The United Nations Single Convention on Narcotic Drugs governs the procurement, supply and dispensing of opioid drugs. In this course we refer to strong opioids, all of which are listed under Schedule I of this convention. This means they are subject to the strictest control measures because of their potential to cause harm at individual and societal levels. Governments are able to impose further restrictions, such as the The Misuse of Drugs Act, 1971, in the United Kingdom and The Controlled Substances Act in the United States. These legal restricitions, however, must not be at the expense of access to opioids for legitimate medical use.
Opioids account for more reported drug errors in hospital than any other high-risk medication (Alanazi et al, 2016). Denison Davies et al (2011) demonstrated that almost 30% of all opioid prescriptions in one hospital contained errors, a third of which were potentially serious or lethal. Similarly, in their study of inpatient palliative care units, Heneka et al (2018) found that 37% of opioid errors caused harm that required medical intervention.
The legal and safety issues of opioids creates a tension which we, as clinicians, must negotiate each and every time we prescribe or administer these drugs.
The role of education in opioid safety
We created in response to The World Health Organization’s call for more education to prevent medication errors. The role of education to make opioid prescribing safer is widely acknowledged and has been shown to improve prescriber behaviour and reduce opioid-related deaths (Leeche et al, 2017; Cochella and Bateman, 2011).
As a clinician with a special interest in safe medicines management at end of life, safe opioid prescribing is really important to me, and I am always keen to seek out and share good practice.
In the next step you can, if you feel able to, share your experiences of prescribing opioids.
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