Long acting opioids less than 50mg per day OME
Codelist metadata
- Coding system
- Pseudo BNF
- Coding system release
- 86 (2024-01-01)
- Organisation
- OpenSAFELY
- Codelist ID
- opensafely/long-acting-opioids-less-than-50mg-per-day-ome
- Version ID
- 0a6dfcc4
About
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
Signed off by
- Chris Wood, (Feb. 6, 2024)
- Vicky Speed, (Feb. 6, 2024)
Codelists are developed by a broad community of users for individual study purposes, which may or may not meet the needs of other studies. They should not be thought of as universal definitions of a particular condition.
We don't offer any guarantees about what they do or don't identify. Users should carefully check that any codelist meets their needs, and seek clinical input where appropriate.
Codes not in the full codelist are in faint grey.
Chapter 04: Central Nervous System
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