Reducing opioid related harm by reducing inappropriate prescribing

Staffordshire and Stoke-on-Trent Integrated Care Board

Project summary

Managing chronic non‑cancer pain without opioids remains a national medicines safety priority because alongside insufficient evidence of effectiveness of long-term opioids, there are increased risk of harm. Opioids are associated with side-effects such as constipation and nausea, but also long-term harm such as falls and fractures, addiction and overdoses.

Staffordshire and Stoke-on-Trent (SSOT) Integrated Care Board (ICB) is the sixth highest prescriber of long‑term opioids in England, with prescribing rates significantly above the national average. A local general practice audit of 1,650 patients on high-dose opioids found misuse/abuse in 6.7% of patients and interventions delivered for only 46.2% of all patients. These highlighted the need for a coordinated system-wide approach to improve prescribing and strengthen support for patients living with chronic pain.

In response, the SSOT ICB Medicines Optimisation team, in collaboration with Health Innovation West Midlands, set out plans to improve prescribing of opioids. System mapping and a general practice survey found key barriers to opioid deprescribing in general practice and how the medicines optimisation team could help overcome barriers. This led to the establishment of a System Wide Opioid Working Group with multidisciplinary stakeholders from across the system to support development of resources, training and quality improvement initiatives.

Central to the project is the recognition that effective chronic pain management extends beyond medication. Evidence suggests that non-pharmacological therapies that focus on improving quality of life for the patient can be effective and has less risk of harm than medicines. And it is estimated that for every 62 patients with chronic pain who can be supported with alternatives to long-term opioids, one life can be saved.

Together we have delivered resources, including opioid and gabapentinoid tapering packs and a chronic pain guideline, targeted training and quality improvement schemes promoting safer opioid prescribing.

Early outputs demonstrate a successful roll-out of opioid tapering; during 2025/26 GP practices reviewed 2,166 patients prescribed opioids: 43% were willing to consider tapering, 31% signposted to self‑management support and patients reported improvements in function, including sleep, mobility, mood, and social engagement. For 2026/27 our quality improvement initiative has been refined based on feedback, with work to further promote pain management reviews to reduce inappropriate prescribing of opioids, and now also gabapentinoids, as well as continued signposting to self-management strategies that can help patients live better alongside pain.