Description

User requirements

A codelist is needed of all long acting opioids with an oral morphine equivalence (OME) of <50mg per day - used for analgesia (any route) excluding cough suppression, motility, general anaesthesia, opiate use disorder - this is for a project looking at opioid prescribing for patients on hospital waiting lists.

Sensitivity versus specificity

Any opioid as a modified release formulation or transdermal patch with daily OME < 50mg based on standard dosing.

Relevant definitions or links to important reference sources

Opioid equivalence - https://fpm.ac.uk/opioids-aware-structured-approach-opioid-prescribing/dose-equivalents-and-changing-opioids

Existing relevant codelists

Nil found

Methodology

Search terms / synonyms / search strategy

BigQuery used to identify relevant products from BNF data. dm+d data used to filter for modified release/patch versions as appropriate. Faculty of Pain Medicine OME conversions used to calculate daily OME - usual licensed dosing used to determine OME (for example morphine sulphate MR products licensed for twice a day administration (with exception of MXL) - so if prescribed 60mg tablet assume taking twice a day (120mg / day total) - or for MXL assume taking once a day so would be prescribed 120mg tablet to meet 120mg/day total.

SELECT DISTINCT presentation_code as code, presentation as term FROM hscic.bnf p INNER JOIN dmd.vmp vmp ON CONCAT(SUBSTR(p.presentation_code,0,9),'AA', SUBSTR(p.presentation_code,-2), SUBSTR(p.presentation_code,-2)) = vmp.bnf_code INNER JOIN dmd.vpi AS vpi ON vmp.id = vpi.vmp INNER JOIN dmd.ont AS ont ON vmp.id = ont.vmp INNER JOIN dmd.ontformroute AS route ON ont.form = route.cd WHERE ((vpi.ing = (60886004) AND route.descr LIKE '%modified-release.oral' AND p.presentation NOT LIKE '%MXL%' AND strnt_nmrtr_val/(COALESCE(strnt_dnmtr_val,1)) <25) /* Morphine Sulfate MR oral preps [excluding MXL as 24hr] (ing code) */ OR (vpi.ing = (60886004) AND route.descr LIKE '%modified-release.oral' AND p.presentation LIKE '%MXL%' AND strnt_nmrtr_val/(COALESCE(strnt_dnmtr_val,1)) <50) /* MXL (ing code) */ OR (vpi.ing = 387024006 AND route.descr LIKE '%modified-release.oral' AND p.presentation NOT LIKE '%Onexila%' AND strnt_nmrtr_val/(COALESCE(strnt_dnmtr_val,1)) <17) /* Oxycodone MR oral preps [excluding Onexila as 24hr] (ing code) */ OR (vpi.ing = 387024006 AND route.descr LIKE '%modified-release.oral' AND p.presentation LIKE '%Onexila%' AND strnt_nmrtr_val/(COALESCE(strnt_dnmtr_val,1)) <33) /* Oxycodone MR oral preps [only Onexila as 24hr] (ing code) */ OR (vpi.ing IN (441757005, 442699004,40755011000001109) AND route.descr LIKE '%modified-release.oral' AND strnt_nmrtr_val/(COALESCE(strnt_dnmtr_val,1)) <63) /* Tapentadol HCl/Phosphate MR oral preps (ing code) */ OR (vpi.ing IN (386858008, 108505002) AND route.descr LIKE '%modified-release.oral' AND (p.presentation NOT LIKE '%Tradorec XL%' AND p.presentation NOT LIKE '%Zamadol 24hr%' AND p.presentation NOT LIKE '%Zydol XL%' AND p.presentation NOT LIKE '%Dromadol XL%') AND strnt_nmrtr_val/(COALESCE(strnt_dnmtr_val,1)) <250) /* Tramadol HCl/ Tramadol MR 12 hour oral preps (ing code) */ OR (vpi.ing IN (386858008, 108505002) AND route.descr LIKE '%modified-release.oral' AND (p.presentation LIKE '%Tradorec XL%' OR p.presentation LIKE '%Zamadol 24hr%' OR p.presentation LIKE '%Zydol XL%' OR p.presentation LIKE '%Dromadol XL%') AND strnt_nmrtr_val/(COALESCE(strnt_dnmtr_val,1)) <500) /* Tramadol HCl/ Tramadol MR 24 hour oral preps (ing code) */ OR (vpi.ing IN (44508008, 387485001) AND route.descr LIKE '%modified-release.oral' AND strnt_nmrtr_val/(COALESCE(strnt_dnmtr_val,1)) <5) /* Hydromorphone (ing code) */ OR (vpi.ing IN (322538006, 387322000) AND route.descr LIKE '%modified-release.oral' AND strnt_nmrtr_val/(COALESCE(strnt_dnmtr_val,1)) <250) /* Dihydrocodeine (ing code) */ OR (vpi.ing = (387173000) AND route.descr LIKE 'patch.transdermal' AND strnt_nmrtr_val/(COALESCE(strnt_dnmtr_val,1)) <=20) /* Buprenorphine patches (ing code) */ OR (vpi.ing = 373492002 AND route.descr = 'patch.transdermal' AND strnt_nmrtr_val/(COALESCE(strnt_dnmtr_val,1)) <=12)) /* Fentanyl patches (ing code) */ GROUP BY code, term

Inclusion criteria for codes

Any modified release or transdermal opioid with daily OME <50mg/day (based on licensed dosing).

Exclusion criteria for codes

N/A

Borderline cases

N/A

References

• GitHub issue

Signed off by

• Chris Wood, (Feb. 6, 2024)
• Vicky Speed, (Feb. 6, 2024)