*MEDICINE* - long acting opioids

[richiecroker]

I have created codelists from the OpenPrescribing measure definitions for both high and "non-high" strength long-acting opioids. The denominator is the full list minus the high dose ones, as defined in the relevant codelist:

High dose: https://www.opencodelists.org/codelist/user/richard-croker/high-dose-long-acting-opioids-openprescribing/5c42deb7/ Non-high dose: https://www.opencodelists.org/codelist/user/richard-croker/non-high-dose-long-acting-opioids-openprescribing/44b769a3/

[chrisjwood16]

@richiecroker re High dose opioid list. Was difficult to fully review in existing form so I've created a new list for comparison. There are a few differences: https://www.opencodelists.org/codelist/user/richard-croker/high-dose-long-acting-opioids-openprescribing/5c42deb7/diff/1d638311/

• [x] MXL appears to be a 24-hour rather than 12 hour release. https://www.medicines.org.uk/emc/product/1016/smpc#gref - So should only include MXL 120mg, 150mg, 200mg

• [x] Onexila XL - similar to above - XL licensed for once a day dosing. So would restrict to only 80mg strength.

• [x] Tapentadol - potency is given as 0.4. I would make tapentadol MR 150mg BD equivalent to 120mg OME - so would include tapentadol MR 150mg preps.

• [x] Hydromorphone - not much use but 16mg MR and 24 MR given twice a day would exceed 120mg OME

Happy to discuss.

• [ ] Is it worth also mentioning somewhere that heroin substitutes are excluded (based on conversions some of the once daily sublingual buprenorphine would be >120mg OME)?

[richiecroker]

Thanks @chrisjwood16 - apologies, the link above is the old version including MXL - i'd already removed the 60mg and 90mg Latest version: https://www.opencodelists.org/codelist/user/richard-croker/high-dose-long-acting-opioids-openprescribing/3f51e9b7/

[richiecroker]

@chrisjwood16 have created new version, which appears the same as your review: https://www.opencodelists.org/codelist/user/richard-croker/high-dose-long-acting-opioids-openprescribing/22c902fd/diff/1d638311/ https://www.opencodelists.org/codelist/user/richard-croker/high-dose-long-acting-opioids-openprescribing/22c902fd/diff/1d638311/

[richiecroker]

@chrisjwood16 have also amended "non-high" opioids: https://www.opencodelists.org/codelist/user/richard-croker/non-high-dose-long-acting-opioids-openprescribing/70aa1c92/

And the diff suggests there's no commonality between two codelists (which is correct) https://www.opencodelists.org/codelist/user/richard-croker/high-dose-long-acting-opioids-openprescribing/22c902fd/diff/70aa1c92/

[chrisjwood16]

@richiecroker non-high dose, long acting opiates. See diff: ~https://www.opencodelists.org/codelist/user/richard-croker/non-high-dose-long-acting-opioids-openprescribing/44b769a3/diff/09b98fc8/~ https://www.opencodelists.org/codelist/user/richard-croker/non-high-dose-long-acting-opioids-openprescribing/70aa1c92/diff/579aa95d/

• [x] Buprenorphine 15micrograms/hour inc brands missing
• [x] Hydromorphone MR 2mg, 4mg and 8mg missing (as above)
• [x] Onexila XL 40mg missing (as above)
• [x] Tapentadol MR 25mg inc brands missing
• [x] Remove tapentadol MR 150mg (as above (120mg OME))

To consider: Dihydrocodeine modified release and tramadol modified release haven't been included but I would say do fit the description of non-high dose, long acting opioids. As 'weak' opioids, they might be more likely to be used for acute courses, but doses convert to higher OME than a number of other opioids included already and for example, DHC CONTINUS is licensed for severe chronic pain.

[richiecroker]

@chrisjwood16 latest diff version here: https://www.opencodelists.org/codelist/user/richard-croker/non-high-dose-long-acting-opioids-openprescribing/0013e8c8/diff/579aa95d/

Main differences: I've not added anything above presentation level DF118 is not long acting (tds) AND discontinued... Added generically rxed DHC continus

[chrisjwood16]

Thanks @richiecroker Happy to approve these final codelists: High dose: https://www.opencodelists.org/codelist/user/richard-croker/high-dose-long-acting-opioids-openprescribing/22c902fd Non-high dose: https://www.opencodelists.org/codelist/user/richard-croker/non-high-dose-long-acting-opioids-openprescribing/0013e8c8