Background and aims: Opioids are often prescribed to patients with chronic non-malignant pain before referral to specialist pain services, but the evidence to support their use in this setting is limited. This study aims to assess the prescribing of opioids for patients before referral to a secondary care Pain Medicine Service (PMS) in relation to the wider opioid prescribing pattern for the patient population in primary care across Liverpool Clinical Commissioning Group (LCCG).
Methods: A retrospective analysis of opioids prescribed to patients referred to the PMS at the Royal Liverpool and Broadgreen University Hospitals NHS Trust between June and November 2018. The data were compared to an audit of opioid prescribing in primary care across Liverpool CCG between April and September 2018.
Results: 430 patients referred to the PMS met the inclusion criteria; 279 patients (64.5%) were prescribed opioids on referral; and 21 (4.9%) patients were prescribed high-dose opioids ≥120mg/day morphine equivalent. The PMS reduced the dose of opioids in 61.2% of patients who were prescribed high-dose. City wide; 43280 (8.2%) of the patient population (527,646) were prescribed opioids, 610 prescribed high dose, with 79% of patients prescribed high-dose opioids not under the care of any PMS in the city.
Conclusions: Only a small number of patients prescribed high-dose opioids in primary care are referred to the PMS. The Royal College of Anaesthetists recommends multidisciplinary assessment for patients prescribed ≥120mg/day morphine equivalent. This highlights opportunities for greater collaborative working between primary and secondary care for this patient group.

PATTERNS OF OPIOID PRESCRIBING FOR PATIENTS BEFORE REFERRAL TO A UNIVERSITY HOSPITAL SECONDARY CARE PAIN MEDICINE SERVICE IN LIVERPOOL, UK