Oral Morphine Liquid - new OpenPrescribing measures
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- Vanessa Sherwood
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This article is part of a series: Guest Blogs
- High Dose Dexamethasone
- How I use OpenPrescribing in my practice as a GP
- Conducting Research Using OpenSAFELY: My Experience of the Co-pilot Service
- Using electronic health records and open science in the COVID-19 pandemic
- Exploring the Impact of COVID-19 on common infections: Treatment Pathways, Antibiotic Prescribing, and Exposure
- Incidence and management of inflammatory arthritis in England before and during the COVID-19 pandemic
- Updates of OpenSAFELY Research on COVID-19 Therapeutics
- Understanding Repeat Antibiotic Prescribing in the Pandemic: Insights On Health Inequalities
- Trends in inequalities in avoidable hospitalisations across the COVID-19 pandemic
- Prescribing of Lidocaine Plasters
- The safety of antivirals and neutralising monoclonal antibodies used in prehospital treatment of Covid-19
- Investigating weight gain and obesity with OpenSAFELY
- Optimising Antibiotic Use in Primary Care
- Oral Morphine Liquid - new OpenPrescribing measures
At the recent Bennett Institute Medicines Symposium, Vanessa Sherwood spoke about her experience of using OpenPrescribing within her PCN to reduce prescribing of oral liquid morphine and improve patient safety. Her work prompted us to develop two new measures based on this approach which we are pleased to now have live on the site:
- Total volume of oral morphine solution prescribed per registered patient
- Prescribing of oral morphine solution in quantities over 300 ml
Below, Vanessa provides further background and context.
Why look at oral liquid morphine?
Oral liquid morphine is a Controlled Drug (CD) Schedule 5, which means that the only applicable CD regulation is that invoices must be kept for two years. This appears to be an anomaly in CD scheduling because 100 mL of oral liquid morphine 10 mg/5mL, which contains 200 mg of morphine, is a Schedule 5. However, if you want to prescribe a total of 200 mg of morphine as oral tablets it would be a CD Schedule 2. For Schedule 2 CDs there are prescription writing requirements, along with legal requirements for safe custody and CD register entries. The use of oral liquid morphine is popular in many acute Trusts as it means that there is less paperwork and people can be treated, transferred and discharged more easily and quickly. It may then be continued in primary care if patients ask for further analgesia.
Oral liquid morphine contains high quantities of alcohol and sugar which in combination with the morphine can make it an even-more addictive substance for some. Many pharmacists will have heard of people “swigging” prescription oral liquids from the bottle but, in the case of liquid morphine, that could be fatal. Oral liquid morphine continues to be implicated in drug-related deaths and has been identified by coroners in a number of Prevention of Future Death reports.
Using OpenPrescribing to drive change in practice
At the Bennett Institute Medicines Symposium in December 2025 I showed how I had used a monthly search that I had set up for oral liquid morphine (shown below) to reduce the prescribing in my PCN (Weymouth & Portland). In three and a half years we achieved a significant reduction in the number of items, by using the OpenPrescribing search results to track and encourage progress along with a high-impact photo (shown below) of the equivalent amounts of morphine, plus alcohol and sugar as excipients in 300 mL Oramorph®.
OpenPrescribing chart showing reducing trend for prescribing of morphine sulphate 10mg in 5ml for Weyland & Portland PCN.
A photo visualising the morphine, sugar and alcohol content of a 300ml bottle of Oramorph®. Photo courtesy of Brian Charlton.
Reflections
I would encourage all doctors, pharmacists and non-medical prescribers in primary care to think carefully about continuing oral liquid morphine that may have been started in hospital. I would also encourage leading clinicians, including pharmacists, in secondary care to think of a better way of ensuring that patients get the analgesia they require on discharge. Do they really need an opioid or is it just an “insurance policy”? And, if they need an opioid, do they really need a liquid full of alcohol and sugar?