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This page was last updated: February 17, 2006
Re-published below is a press release issued by the Royal Pharmaceutical Society on the 13th February 2006.
News release
For immediate release
13 February 2006
PRACTICE COMMITTEE CONSIDERS OPIOID ISSUES
The prescribing of sustained release morphine preparations and opioid patches was discussed
at the Practice Committee on 18 January 2006.
In line with current thinking, committee members agreed that sustained release morphine
preparations and opioid patches should be prescribed by brand name. The view was that there
may be small, but significant differences in release rates for the various sustained release
preparations which could affect the balance for individuals. The committee felt that it was
important that the dose of morphine and other strong opioids should be carefully titrated to a
patient’s individual need, as there was a fine balance between under and over dosing.
The Committee was concerned that generic prescribing of sustained release opioid
preparations, which included patches, could potentially create confusion for the prescriber and
the patient. With generic prescribing there was no guarantee that patients would receive the
same brand each time they had a prescription dispensed since community pharmacists often
had no way of knowing what had been dispensed previously. This problem has been
highlighted in Building a safer NHS for patients – improving medication safety (DH 2004) which
recommended brand prescribing of oral sustained release preparations.
The Practice Committee noted that patients were often alarmed if their medication changed in
appearance. The Committee had concerns that if a patient changed brands of a product
without appropriate counselling that there was the potential for confusion. This could mean that
the patient did not take or use their medication appropriately. For strong opioids this could
have serious consequences and could either lead to unnecessary pain for a patient, hospital
admission or death as a result of overdosing.
The Committee agreed that with patches, changing brands was an even greater issue, as
patients became used to using a specific patch. It is known that patients do develop a
preference for a specific patch which could be for a variety of reasons including shape,
thickness, colour, type of adhesive, incidence of skin irritation or type of packaging.
Inadvertently changing the brand of patch could affect the way patients use the medication.
From a patient safety perspective, the Practice Committee agreed that it is important that
patients should have continuity of supply of their medication and recommended that sustained
release morphine preparations and strong opioid patches should be prescribed by brand
name. They considered this to be particularly important for Fentanyl where there were both
matrix and reservoir patches available.
Sid Dajani, Chair of the Practice Committee says: “To improve patient safety, compliance and
efficacy, the Society strongly endorses the continuity of supply of the same brand of sustained
release morphine preparations and opioid patches for patients and would support the
requirement to prescribe these products by brand name. To help identify which brand of
sustained release morphine or opioid patch a patient has received pharmacists should record
the brand dispensed in their PMRs especially as many prescriptions are currently written
generically.”
The Practice Committee will be pursuing this matter with the BNF and taking this important
issue back to the Council.
For further information please contact the public relations unit of the
Royal Pharmaceutical Society of Great Britain on 020 7572 2335/6
1 Lambeth High Street, London SE1 7JN
Tel: 020 7572 2335
Fax: 020 7572 2503
