Safe opioid prescribing and opioid stewardship

At a glance

• Opioid harm follows from pharmacology: dose-related respiratory depression, potentiation by other CNS depressants, tolerance, dependence and hyperalgesia.
• Express total exposure as oMEDD using the ANZCA Faculty of Pain Medicine factors (October 2025 update).
• ANZCA's Appendix 2 states that oMEDD above 40 mg carries about a four-fold, and above 100 mg about an eleven-fold, increase in cardiorespiratory events. The underlying cohort studies band dose differently: compared with 1 to 20 mg/day, overdose risk is about 4-fold at 50 to 99 mg and about 9-fold at 100 mg or more (Dunn 2010), with Bohnert 2011 giving 5- to 12-fold at 100 mg or more depending on indication.