Table 1

WHO guide to good prescribing and opioid prescribing in CNCP guidelines

WHO Principles of Good Prescribing28 Guidelines for prescribing opioids for CNCP10 20–22
Step 1Define the patient’s problem
  • Assess the patient using a multidisciplinary approach.

  • Non-pharmacological therapy and non-opioid pharmacological therapy are preferred for CNCP.

Step 2Specify the therapeutic objective
  • Before starting opioid therapy, clinicians should establish realistic treatment goals with the patient and set a review date. Written, structured clinician-patient agreements/contracts for opioid use could be considered.

Step 3Verify the suitability of the medication
  • A careful assessment of the benefits and risks of prescribing an opioid for each specific patient should be considered.

Step 4Write a prescription
  • Start with a low dose and adjust slowly according to response.

  • Do not introduce an opioid at the same time as another drug.

Step 5Give information, instructions and warnings
  • Discuss the adverse effects, possible harms and realistic benefits of long-term opioid therapy with patients.

Step 6Monitor (and stop?) the treatment
  • Regularly review the patient to monitor progress, evaluate benefits and harms, and assess if ongoing treatment is needed. Reviews should be within 4 weeks of starting opioid treatment or of changes in dose, and minimum every 3 months for continued treatment.

  • If opioid treatment is ineffective, or benefits do not outweigh harms, then opioid treatment should be tapered slowly and under supervision.

  • CNCP, chronic non-cancer pain; WHO, World Health Organization.