Opioids in the frailer adult: Are we prescribing them safely?

Introduction:
Chronic pain is common and increases with age. It is challenging to treat and opioids are frequently used. However, these come with potentially dangerous side effects.  We sought to review the prevalence of these drugs across our Medicine of the Elderly department, our prescribing practice and our communication with primary care regarding them. 

Method:
Between the months of April and May 2025, we reviewed all patient records across the MoE footprint (142 patients) recording presence of opioid, type, whether present on admission, started ourselves, frequency of review, plan and communication at discharge. 

Results:
36 patients were taking a regular opioid (28%), of which 17 were taking prior to admission (48%). 6 different opioids were being used. 36 patients (28%) were started on an opioid, 24 were sent home with opioids (66%). All had comments regarding opioids in text to GP on discharge summaries. 11 had advice to review and wean. 9 noted necessity to remain on opioid for pain control. 4 noted they had been started but gave no advice as to next steps. During the study period, median time on opioids was 14 (range 2 - 184). The median number of pain reviews was 2 (range 0 – 10). The median number of opioid plans in the patient record was 3 (range 0 -17). 

Conclusion:
We found opioid use to be common. Pain assessments and opioid reviews during admission were infrequent and inconsistently documented, arguable particularly important for patients newly commenced on opioids. While discharge communication highlighted the presence of opioids well, advice on further prescribing was not always shared with Primary care. Given the vulnerability of older adults to opioid related harm, this audit highlighted the need for more stringent prescribing behaviour and information reconciliation and will for the basis of ongoing improvement work.