Evidence-based practice guidelines recommend that specialist advice should be sought for patients requiring opioid doses exceeding oral morphine 100mg daily, oxycodone 60mg daily or equivalent, for the treatment of chronic non-cancer pain, or when prescribing opioids to a patient with a history of drug dependency or aberrant drug-related behaviours. Opioids should only be prescribed as part of a comprehensive pain management plan. When applying for a permit to treat a patient with an opioid, applicants may be requested by the Secretary to provide the Secretary with evidence of a pain management plan or specialist review.
The morbidity and mortality risks associated with long term opioid therapy should be discussed with the patient; in particular the increased
mortality risks correlated with the prolonged use of opioids at doses exceeding 100mg daily in morphine equivalents.