French National Guidelines for the Appropriate Use of Opioids: Analgesia, Opioid Use Disorder, and Overdose Prevention—Part 1: Methodology and Pain Management

Opioid medications play a central role in pain management but are associated with significant risks, including dependence, opioid use disorder (OUD), and overdose. In response to rising concerns, the French National Authority for Health convened a multidisciplinary working group to develop updated guidelines on the appropriate use of opioids. These recommendations, grounded in the high-level international evidence and developed through a rigorous formal consensus method, represent the most comprehensive and recent guidelines addressing the entire opioid pharmacological class, regardless of indication. The first part focuses on the clinical use of opioid analgesics in acute and chronic pain, both cancer-related and non-cancer-related. The guidelines emphasize prudent prescribing, prioritization of non-opioid therapies, and the integration of multimodal analgesia. Specific clinical situations are addressed, including management in primary care, emergency settings, postoperative care, inpatient treatment, and the perioperative management of patients already receiving opioids or opioid agonist treatment. Practical tools such as equianalgesic conversion principles, criteria for opioid rotation, and strategies to minimize adverse effects are provided to support prescribers. By considering opioids as a single pharmacological class, these guidelines enable consistent principles to be applied across diverse clinical contexts, from the initiation of short-term opioid therapy to the safe management of patients with complex dependence profiles. Although developed in France, the recommendations are intended to have international relevance, given their reliance on global evidence and their focus on balancing effective pain relief with risk reduction. A second part, addressing the prevention and management of OUD and overdoses, complements the present manuscript. Opioid medicines, also called opioid analgesics, can play a role in pain management. They may be used for acute pain (such as after surgery or an injury), chronic pain, and cancer-related pain. However, these medicines are linked to important risks, including dependence, opioid-related disorders, and overdose. To address these issues, the French National Authority for Health developed national practice guidelines based on the strongest international evidence. This first part of the guidelines focuses on the safe and appropriate use of opioids for pain relief. The recommendations were developed with input from doctors, pharmacists, addiction specialists, patients, and public agencies. The recommendations explain when opioids are needed, when they should be avoided, and how long they should be prescribed. In acute pain, opioids should only be used in specific situations, for the shortest time possible, and always combined with non-opioid treatments. In chronic non-cancer pain, long-term opioid use should be limited to carefully selected patients under close supervision. In cancer-related pain, opioids remain essential, with detailed advice on how to adjust treatment, switch between medicines, and prevent side effects. By considering opioids as a single drug class, these guidelines provide consistent and practical tools for healthcare professionals across many settings. Together with Part 2 of the guidelines, they aim to improve patient safety by balancing effective pain management with the prevention of opioid use disorder and overdoses.