The Medicines and Healthcare products Regulatory Agency (MHRA) has issued new guidelines advising against the use of prolonged-release opioids for postoperative pain relief. This decision follows a review by the Commission on Human Medicines (CHM), which concluded that the risks associated with prolonged-release opioids, such as morphine sulphate and oxycodone, outweigh their benefits for short-term postoperative pain. Health professionals are now urged to discuss potential risks of persistent postoperative opioid use (PPOU) with patients prior to surgery and to explore alternative pain management strategies.
Understanding Persistent Postoperative Opioid Use
Persistent postoperative opioid use, or PPOU, is defined as the continued use of opioids beyond 90 days after surgery. It is a significant concern for patients who undergo surgery and those with underlying respiratory conditions. The MHRA highlights that PPOU affects 2% to 44% of patients treated with prolonged-release opioids. This risk escalates to 60% for patients who are already on these medications preoperatively.
Evidence from both the European Union and the UK emphasizes the seriousness of PPOU. International estimates show that the incidence ranges from 0.4% to 41% of patients, illustrating the global scope of this issue. Furthermore, between 11% and 77% of prescribed opioids go unused worldwide, underscoring the potential for misuse and dependency.
New Recommendations for Healthcare Professionals
In response to these concerns, the MHRA has removed postoperative pain relief from the licensed indications of prolonged-release opioids. Healthcare professionals are advised to engage in comprehensive discussions with patients about the risks associated with PPOU before surgery. This includes reviewing any preoperative opioid treatments in accordance with Consensus Best Practice Guidelines.
The MHRA also recommends utilizing immediate-release opioids and multimodal analgesia as part of a broader pain management strategy. These measures aim to reduce reliance on prolonged-release opioids and mitigate the risks associated with long-term use.
Reporting and Monitoring
The MHRA encourages healthcare providers to report instances of PPOU through the Yellow Card Scheme, a system designed to monitor drug safety and collect data on adverse effects. By reporting these cases, health professionals can contribute to a better understanding of PPOU and its implications for patient safety.
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