Intended for healthcare professionals


UK recommendations on opioid stewardship

BMJ 2021; 372 doi: (Published 05 January 2021) Cite this as: BMJ 2021;372:m4901
  1. Nicholas Levy, consultant anaesthetist1,
  2. Linda J Lord, chief pharmacist2,
  3. Dileep N Lobo, professor of gastrointestinal surgery3
  1. 1Department of Anaesthesia and Perioperative Medicine, West Suffolk NHS Foundation Trust, Bury St Edmunds, UK
  2. 2NHS West Suffolk Clinical Commissioning Group, Bury St Edmunds, UK
  3. 3Nottingham Digestive Diseases Centre and NIHR Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
  1. Correspondence to: N Levy nicholas.levy{at}

A wider and more coordinated approach is necessary

The effect of the prescription opioid crisis in North America is well documented.1 In 2018 some 68 500 Americans died from opioid overdoses, and in 2015 the cost of opioid misuse to the US economy was estimated at $150bn (£110bn; €120bn).1 The EU now has an estimated 1.3 million high-risk opioid users,1 and 110 000 people worldwide died from opioid use disorders in 2017—77% more than in 2007.2

Opioids were prescribed to roughly 5% of the UK population in 2015.3 Between 1998 and 2016, opioid prescriptions increased by 34% in England, and the total oral morphine equivalence dose increased by 127% to 431 000 mg/1000 population/year.4 A recent UK study found that 14.6% of people given opioids for the first time became long term opioid users within a year.5

In response to this healthcare crisis, the UK Medicines and Healthcare Products Regulatory Agency (MHRA) has issued recommendations that before prescribing opioids, clinicians must discuss the risks and …

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