Opioids users should have annual reviews to protect them from potential harm, says updated Scottish guidelines

Patients who are given opioids for pain relief should have their medicines reviewed soon after they are prescribed and at least annually after that, according to updated guidance from the Scottish Intercollegiate Guidelines Network (SIGN).

The updated guidance, which was produced after a review of the latest evidence of potential harm from opioids, aims to protect patients from addiction and overdose, as well as the side effects taking opioids, such as falls.

“All patients on opioids should be assessed early after initiation, with planned reviews thereafter,” the guidance states. “These should be reviewed annually, at a minimum, but more frequently if required.”

The guidance also states that “consideration should be given to a gradual early reduction to the lowest effective dose or complete cessation”.

According to a statement from Health Improvement Scotland, which oversees SIGN, there were 2,679,182 prescriptions for opioids dispensed in Scotland in 2018/2019, at a cost of around £29m.

“Opioids are powerful medicines,” said Lesley Colvin, co-chair of the Guideline Development Group and professor of pain medicine at the University of Dundee.

“The purpose behind this review is to ensure that those who benefit from [taking] opioids for chronic pain continue to get the relief they need, but are also protected from potential harmful effects.”

Colvin said that opioids should only be started after “careful” assessment that benefits outweigh the risks for continuing use.

Safia Qureshi, director of evidence for Healthcare Improvement Scotland, said: “It’s important that those who need strong pain relief get the medication they need, but are kept safe from the dangerous side-effects associated with these powerful medicines.”