Organisational practices in postoperative opioid prescribing at discharge in UK NHS Day Surgery Units: the OPIOID-Discharge survey

Background: In March 2025, the Medicines and Healthcare products Regulatory Agency published a drug safety update removing the indication of postoperative pain from the licence of prolongedrelease opioids and mandated discussing risks with patients. This study assessed compliance with these recommendations six months post-publication. Methods: A cross-sectional survey on organisational discharge opioid prescribing practices was distributed via the National Confidential Enquiry into Patient Outcome and Death Local Reporter pathway to acute hospitals in England, Wales, and Northern Ireland. Surveys targeted Day Surgery Unit managers and Drugs and Therapeutics Committee secretaries. Results: We received responses from 83 Day Surgery Units and 70 Drug and Therapeutics Committees (~68% response rate). Before March 2025, 73% of Trusts routinely used modified-release opioids. Following the drug safety update, 84% of committees shared the guidance, and consequently 75% of organisations that previously used modified-release opioids no longer do so. However, 14% of units still dispensed modified-release opioids. Only 32% of discharge letters advised General Practitioners against repeat prescriptions, and 28% of units provided patient information on opioid risks. Formal training on acute post-operative pain management was confirmed for only 27% of prescribers. Conclusion: Six months after the drug safety update, there is evidence of significant impact, with the majority of Trusts sharing the alert and moving away from modified-release opioids. However, substantial work is still required. Key gaps include continued dispensing of modified-release and combination opioids, and poor communication with patients and General Practitioners regarding opioid risks and safe disposal.