A third aim described by nurses in the use of AMs was to start at the lowest prescribed dose and work within local and national guidance; this was described as doing it ‘by the book’. At some sites, drug doses were prescribed within a narrow range allowing nurses some discretion. All nurses reported they would always start with the lowest dose, but that a range allowed them to increase the dose if necessary without calling the GP. However, not all were comfortable with using a range, with some seeing this as a difficult additional responsibility. Nurses expressed particular caution with those patients considered to be ‘opiate naïve’ or frail: