5.3 million people, and the question that matters most

New research reported in Pharmacy Magazine estimates that over 5.3 million people in the UK are prescribed opioids every year. The report, commissioned by pain relief brand Combogesic and carried out by York Health Economics Consortium, puts the wider economic burden at £1.17 billion a year. Unnecessary opioid prescribing alone is estimated to cost the NHS around £240 million annually.

The report also states that an average of 40 people die each week from opioid-related causes. That figure is likely to include illicit opioid use, so it should not be read as a measure of prescribing harm on its own. It is still a reminder of how serious these medicines are.

For our clinical pharmacists, the most important number is not how many people start opioids. It is how many never stop.

Every week, our team at Clinical Pharmacist Solutions (CPS) carries out opioid reviews in GP practices and primary care networks (PCNs). We regularly meet patients who started an opioid for a short-term reason and are still taking it years later, often without a clear plan for review or reduction. So the question we want to put to colleagues across primary care is simple. Are we doing enough to stop patients becoming long-term opioid users in the first place?

Why the three-month mark matters

The report’s co-author, pharmacist Mark Burdon, links opioid use of three months or more to a high risk of addiction. That threshold is not new. In September 2020 the MHRA concluded that long-term opioid use for non-cancer pain, defined as longer than three months, carries an increased risk of dependence and addiction, even at therapeutic doses.

The MHRA asked prescribers to discuss tolerance, dependence and addiction with patients before prescribing. It also asked them to agree a treatment strategy together, including a plan for ending treatment, and to taper slowly when that time comes. From a high dose, tapering can take weeks or months.

For chronic primary pain, NICE guideline NG193 goes further and advises that opioids should not be started at all. Where a patient is already taking them, prescribing should be reviewed through shared decision making.

So three months is less a prescribing limit and more a warning point. If a patient reaches it without a review, the balance of risk has already started to shift. Should every opioid started for non-cancer pain carry a review date before that point?

What deprescribing conversations look like in practice

For patients who have taken opioids for many years, reducing or stopping is rarely straightforward. Concerns about worsening pain, withdrawal symptoms and losing something they have relied on for years are real, and they deserve to be taken seriously.

Our pharmacists give these conversations time. That means understanding why the opioid was started, whether it is still providing benefit and what the patient wants from their treatment. It means building trust before suggesting change, agreeing a pace the patient is comfortable with, and involving the wider multidisciplinary team where pain needs more than a medicines review.

Deprescribing is not simply about stopping medicines. It is about making sure every medicine still has a purpose and supporting patients safely towards better outcomes. Much of this work happens quietly, one review at a time, but it can make a lasting difference to someone’s quality of life.

Getting it right from the first prescription

Long-term use rarely begins as a decision. It tends to build through repeat prescriptions, missed reviews and the lack of a clear exit plan. That raises questions we would like to explore with other clinicians.

• Are we setting clear expectations with patients when an opioid is first prescribed, including how long it is likely to be needed?
• Are reviews happening before the three-month mark, or only once a patient is already established on treatment?
• Do repeat opioid prescriptions get the same scrutiny as the first one?
• Do patients have realistic access to alternatives such as physiotherapy, pain management programmes, psychological support and social prescribing?
• After surgery or hospital discharge, is there a clear plan for stopping? Since March 2025 the MHRA has advised against prolonged-release opioids after surgery and expects a pain management plan to be shared with primary care. But who owns the end of treatment in practice?

This needs more than individual reviews

Pharmacists have an important role in opioid stewardship, but meaningful change needs more than a medication review here and there. It needs consistent approaches across practices, PCNs and integrated care boards (ICBs).

The report found wide geographic variation that did not follow deprivation. In Norfolk and Suffolk, 12.7% of patients were prescribed opioids, compared with 5.39% in West and North London. That suggests local prescribing culture, access to services and review capacity all play a part.

As ICBs shape their medicines optimisation priorities, we think a few questions deserve wider discussion.

• What can we do to ensure every practice or PCN has the right pharmacist capacity to be able to support with these appointments?
• How do we improve access to non-drug pain management, so that reducing an opioid does not leave a patient with nothing?
• What can we do to make sure that clinicians are feeling supported in having these difficult conversations with patients?

We want to hear from you

We would like to hear from GPs, clinical pharmacists, pain specialists, nurses, ICB medicines optimisation teams and anyone else working on safer pain management.

• What has worked in your practice or PCN?
• Where do you see patients getting stuck?
• What would make deprescribing conversations easier to have?

Share your thoughts in the comments on our LinkedIn post, or get in touch to talk about how our clinical pharmacists support opioid reviews and safe deprescribing in primary care.