Opioid prescribing Following the WHO analgesic ladder for acute pain, strong opiate medication is advised at step 3 for acute pain or first line in severe cancer related pain. Patients are often prescribed Oxycodone first line at step 3. The NZ formulary and the guidance for Whakatane Hospital is that morphine sulphate (Sevredol) or liquid morphine hydrochloride (RA-Morph) is the first line for immediate release morphine. Morphine sulphate (M-eslon) is the first line for modified release morphine. Oxycodone will be reserved for second line use if morphine is not tolerated or contraindicated. The issues with oxycodone are the changes in bioavailability and dosing compared with oral morphine and increased potential for opioid addiction.
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