You will know that opioids are commonly used to treat acute and chronic pain. However, are you aware of how often opioids are involved in medication errors? By July 2008, the NPSA had received reports of over 4200 dose related patient safety incidents concerning opioids (NPSA, 2008). Patient harm commonly occurred due to inappropriate doses being prescribed or administered. This was especially true when the patient had no history of taking opioids and could be very sensitive to their effects. This has been so well published by the NPSA that the Department of Health, (2012) has classed it as a ‘never event’. Whenever you prescribe an opioid, you must take a full patient history to determine any previous opioid use. This includes the doses, formulations, and the frequencies of both regular and as required opioids. This enables you to make sure that the dose you are prescribing is safe for the patient. Information on starting doses, as well as dose conversions, of opiates is available in the British National Formulary and can be found under each individual drug name, or in the ‘Prescribing in palliative care’ section. Additional information can also be sourced in the Palliative Care Formulary, in local policies and guidelines, or alternatively, go online to When you increase the dose of an opioid, you should make sure that the calculated dose is safe for the patient. Dose increases should not normally be more than 30 - 50% higher than the previous dose. Wrong product selection is another common cause of errors. You should therefore make sure you are familiar with all the products you are prescribing.


Do you know the difference between these products?


Opioid medicines

Thanks to NAPP Pharmaceuticals for allowing us to photograph these medicine packets.


Morphgesic, MST Continus and also Zomorph are brands of modified release morphine and should be prescribed twice daily and doses administered as 12 hour intervals. Oramorph is a brand of immediate release morphine liquid and this also comes in a more concentrated strength. Sevredol is the immediate release tablet version. These immediate release preparations are prescribed for acute pain relief and breakthrough pain. Morphine sulfate solution for injection is twice as potent as the oral dose. When prescribing modified release it is best to avoid brand names and to prescribe Morphine sulphate modified release or immediate release.

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