Modified release opioids and acute pain

Following our previous position statement around modified release (MR) opioids and the treatment of post-operative pain, we  wish to make clear our position on modified release opioids and acute pain:
 

• MR opioids are not suitable for postoperative pain in opioid-naïve individuals.
• Acute pain should be managed with short-acting opioids, if opioids are needed.
• Modified-release (MR) or long-acting opioids are generally not appropriate for managing perioperative and other forms of acute pain due to:
  • Risk of accumulation and overdose, especially in opioid-naïve patients
  • Delayed onset and offset, which makes titration difficult
  • Prolonged adverse effects (e.g. respiratory depression)
  • Increased risk of long-term prescribing/use of opioids.

• MR opioids may be considered:
  • For patients already on a stable long-acting opioid regimen for chronic pain or palliative care, to prevent withdrawal and maintain analgesia, in particular when the long-acting opioid is being prescribed for pain that is not directly related to the scope of surgery In these patients specialist acute pain input is recommended to explore whether the long acting opioid dosage needs to be adjusted.
  • In acute pain, with specialist pain team input and appropriate monitoring. This is in exceptional circumstances balancing the risks and benefits on an individual patient basis while adhering to local policy and ensuring patient safety.

Relevant resources

• Faculty of Pain Medicine (FPM): Opioids Aware
• BNF (British National Formulary)
• MHRA, Drug Safety Update, March 2025