What the standard says
Whenever an opioid analgesic is considered for a patient with acute pain, their risk of opioid-related harm is assessed. An opioid analgesic may be prescribed when other analgesics are not clinically feasible or sufficient, and the potential benefits outweigh the potential harms.
What this means for clinicians
Identify and document avoidable, modifiable risks of harm if opioid analgesics are prescribed for a patient with acute pain, using appropriate assessment tools where possible.
Patients from some vulnerable groups may be at increased risk of opioid analgesic-related harm. These include older people, infants and children, pregnant and breastfeeding patients, patients with a disability, patients with unstable adverse social circumstances, patients with psychological comorbidities, and patients with substance use disorders.
Patients cannot be reliably assessed for risk of respiratory depression (OIVI). Older age is one risk factor commonly reported as being associated with an increased risk of respiratory depression (OIVI). Follow best practice recommendations for appropriate doses of immediate-release opioid analgesics in older people, such as Therapeutic Guidelines and Acute Pain Management: Scientific evidence.
Other risk factors include chronic opioid analgesic use, chronic sleep-disordered breathing, chronic obstructive pulmonary disease, diabetes, hypertension, hepatic or renal impairment, neurological diseases and obesity.
Modifiable, avoidable risk factors for sedation and respiratory depression (OIVI) include:
- Use of more than one opioid analgesic at a time
- Use of modified-release oral and transdermal opioid analgesics
- Use of continuous opioid analgesic infusions
- Continued administration of opioid analgesics to treat pain that is not responding to opioid analgesics
- Co-administration of central nervous system (CNS) depressants such as benzodiazepines and other sedative hypnotics, barbiturates, gabapentinoids, alcohol and recreational drugs.
Establish the patient’s opioid status and existing opioid analgesics in their possession before prescribing opioid analgesics for acute pain. Access Real Time Prescription Monitoring tools or the Prescription Shopping Program to obtain information on use of other medicines that cause sedation and respiratory depression (OIVI), to inform shared decision making before giving or prescribing opioid analgesics.
For non-opioid naïve patients taking opioid analgesics prior to a planned or elective surgery or procedure, if time allows, slowly reduce opioid analgesics according to recommendations outlined in the current best practice guidelines. For patients identified to be at increased risk of opioid-related nausea and vomiting after surgery, consider opioid-sparing treatments or alternatives to opioid analgesics to manage their acute pain.
Real time prescription monitoring systems:
- QScript (Queensland)
- SafeScript NSW (New South Wales)
- SafeScript (Victoria)
- Canberra Script (Australian Capital Territory)
- DORA (Tasmania)
- ScriptCheck (South Australia)
- Electronic Recording and Reporting of Controlled Drugs (Western Australia).
The system of Real Time Prescription Monitoring (RTPM), on which the state and territory systems are based, is designed to monitor the prescribing and dispensing of controlled medicines with the aim of reducing their misuse in Australia.
Services Australia: Prescription Shopping Program