Reduce harm from inappropriate opioid prescribing for chronic non-cancer pain (2025)

Staffordshire and Stoke-on-Trent Integrated Care Board

Project summary

Staffordshire and Stoke-on-Trent Integrated Care Board is the 5th highest prescriber of opioids for pain relief in England. Our prescribing is currently more than 25% above the national average.

Managing chronic non-cancer pain without opioids is one of the NHS national medicines optimisation opportunities and has been a central part of the National Medication Safety Improvement Programme for several years.

Studies show that patients on regular opioids for chronic pain tend to have worse quality of life compared to patients not on opioids. They are more likely to suffer side-effects and other long-term harm such as bone fractures, addiction and overdose, especially with high doses.

The first Medication Safety Improvement Programme focused on high dose opioid prescribing, and because of this we included an audit on high dose opioid prescribing within the Integrated Care Board Medicines Optimisation priorities. The work was enabled through the local Service Level Agreement with GP practices for 2022/2023. The result that stood out was that practices made treatment interventions for less than 50% of patients despite the evidence for harm.

Early 2023, in collaboration with Health Innovation West Midlands, the Medicines Optimisation team set out a plan to improve prescribing of opioids through an Integrated Care System wide approach. We started by mapping out available services across our system and creating a survey to identify barriers to deprescribing amongst GPs and pharmacists in general practice. The survey showed that barriers include lack of time, society’s need to help people in pain and lack of alternative pain management. When asked how we could help, the majority answered that they wanted deprescribing resources and training, as well as a better pain management service.

An Integrated Care System Wide Core Opioid Working Group, which included subject matter experts from across the system, was formed to create resources and provide specialist training.

Our overall ambition was to increase awareness amongst clinicians and patients about the negative risk-benefit ratio associated with opioid use and to improve patients’ ability to live better alongside pain. For 25/26 our aims are to reduce overall opioid prescribing, by 10%, and to identify potential barriers and motivators to tapering.