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A faulty production line

Government medicine regulator launches major opioids review to cut prescribing

A major review of opioid medicines has been launched by the Government medicines regulator, with the aim of cutting overprescribing and drug misuse.

GPs and other medical specialists form part of the expert group commissioned by the MHRA to carry out the independent review of the scientific evidence relating to opioid medicines.

The group will look at the benefits and risks of opioids, recommend regulatory action to curb inappropriate use, and educate GPs and other clinicians on managing the risks.

This comes after Public Health England launched a review into prescription drug addiction – including opioids - last year, which is due to report this spring.

The MHRA said the new review is in line with but not part of the PHE review.

The review – which comes in response to growing concerns about overuse and misuse – will:

  • look at the current data on prescriptions of opioid-containing medicines in the UK, both prescribed and over the counter
  • consider the benefit/risk of opioid-containing medicines in particular for non-cancer indications, taking into account alternatives
  • make recommendations for regulatory action to better support appropriate use of prescription opioids

The expert group will also work to ‘raise awareness’ among both clinicians and the public on the risks of addiction and how these can be managed, it explained.

The announcement said: ‘The expert working group will undertake a comprehensive independent scientific review of all available evidence on the use of opioid medicines in the UK, drawing on best practice internationally, to make sure the information for patients and health professionals helps curb the over-prescription and misuse of these medicines.’

MHRA vigilance and risk management of medicines division director Dr June Raine said: ‘In response to the growing concern internationally and in the UK about overuse and increased prescribing of opioid analgesics, we are seeking expert advice on the benefits and risks of opioid medicines, including best practice for risk minimisation.'

Expert working group chair Professor Jamie Coleman said: ‘We have set out a clear programme of work to look at regulatory options. We have already planned some initial steps to work with stakeholders to produce consistent and clear label wording that opioid medicines may lead to addiction. We are also going to examine access to opioid medicines.’

But GPs are concerned they will be left without alternative treatments if the review restricts prescribing.

Newcastle GP Dr Phil Brookes, who specialised in drug and alcohol addiction before retiring, said: 'In the last 20 years, the pain clinics have encouraged the increasing use of opioids in the community, they have started the prescriptions and encouraged GPs to continue them.

'My main question would be, what are the other services that can be offered to these patients with non-cancer chronic pain? As a GP sitting in a surgery, you have got patients in front of you, in distress and pain, and you have drugs that will work in the short term and are licensed, and now if they say we are not supposed to use them, what do we do?

'Will alternative services to provided? Otherwise GPs will be left high and dry with frustrated patients.'

BMA GP Committee clinical and prescribing lead Dr Andrew Green said: 'There is no doubt that we have an epidemic of opioid use at the moment, and we need to take great care to ensure that we don’t find ourselves in a similar position to the United States, where prescribing is even higher.

'If GPs are to reduce their prescribing, it is vital that alternatives to medication are provided for the management of patients with long-term pain, a condition for which we know opioids have little place.

'PHE are currently conducting a review into prescription drugs associated with dependence or withdrawal syndromes, and it is strange that two bodies seem to be working separately on two very similar problems.'

PHE's landmark review on prescription drug addiction and dependence was comissioned by the Government last January. It followed official data which found one patient in 11 (8.9%) had been prescribed an addictive medicine.

The review is looking at benzodiazepines, z-drugs, gabapentinoids, opioid pain medicines and antidepressants, and is due to report later this year.

Related images

  • Opioid - oxycodone - pain - RF

Readers' comments (21)

  • "In the last 20 years, the pain clinics have encouraged the increasing use of opioids in the community, they have started the prescriptions and encouraged GPs to continue them"

    I totally agree. I have seen many patients inappropraiately prescribed morphine based medications for osteoarthritis and dubious conditions (ME,fibromyalgia for example). Its completely bonkers. Short term gain for long term pain.

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  • cannabis it is then. oh or cbt

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  • Just this week we had a patient come in requesting we prescribe long term dihydrocodeine as the pain specialist they had consulted had recommended this( there was a letter to back this up)
    What hope in hell have we as 'just GPs' of turning the tide on this opioid epidemic when 'the specialists'are recommending them ?

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  • Ahhhhhh Pain...... Not an easy problem to manage.... who has the time to go through all the factors that influence pain when seeing a patient? Who is going to stop the medications??? Especially opioids... People is addicted... Detox clinics anyone?????

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  • GP is the fall guy again then?
    Part of the no blame culture which just blames the GP

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  • the only way to get people off this stuff is with intensive input and even admission a bit like crisis team input. This will cost loads but it is worth it. AS GPs we know what needs to be done but have no time/resource to do it. Of course if we see more private medicine, the issue will get worse.

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  • I often struggle for months to contain or reduce opiate or gabapentinoid usage in patients, only to refer them to pain clinic and have them return on massive doses of the same - presumably because its the easiest thing to do to get them out of clinic quickly, and with no responsibility for ongoing care.

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  • Perhaps look at the overdiagnosis of fibromyalgia as well...

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  • If the pain clinics initiated the opiates/opioids (and gabapentinoids) it is their responsibility to help patients come off those drugs.

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  • Ceasing funding Pain Clinics would help.

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  • David Banner

    The result of this study will be the usual league tables and graphs from med mgmt naming and shaming high prescribing GPs who will be pilloried again.
    The real answer (which will not happen) is to ban GP prescribing of strong opiates, and force Pain Clinics who initiate these drugs to keep patients on their books under a shared care arrangement (similar to rheumatoid drugs).

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  • Took Early Retirement

    "There is no doubt that we have an epidemic of opioid use at the moment"- ridiculous hyperbole from the BMA spokesman.

    In my career I saw two people commit suicide as a result of severe MSK pain when no one would give them anything stronger than DHC.

    So, GPs stop using MST, patients commit suicide and GP will end up in the dock. You heard it here first.

    I had several people with severe MSK pain on things like low dose fentanyl patches or MST, who use didn't escalate and who were able to live fulfilling lives, in some cases carrying on working.

    And if there is such an "epidemic" then why are we using methadone for drug addicts- none of whom get off it, and almost all of whom don't work?

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  • Took Early Retirement 6.21pm.

    The use of methadone, the cure which is worse than the disease in terms of achieving abstinence, is because society has deemed that those reprobates who for many reasons choose opiates be begrudgingly given something to stop them withdrawing whilst providing no "high" or pleasure which their preferred poison offers.

    Theres some interesting work out there which suggests ultra-low dose naltrexone combined with mu agonists reduce dependence liability (physical and certain aspects of the psychological components). But as our colleague Chris Ho would state, market forces should lead the way, a position the pharma companies endorse fully.Hence the combination doesn't exist, and profits remain excellent. And our pension plans continue to reap the benefit.

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  • Take away the driving licence of anyone on regular high dose opioids.
    That would be a good start

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  • Just got my nasal esketamine spray, 2 squirts and my morning surgery was a blast. Don't care bout anything now,

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  • My patient with severe OA came and thanked me for the morphine which has allowed him to shop and go out and cope with his pain although he still needs to sit down.He has had the same does for years now.People are jumping on the bandwagon of the USA's over usage. We have to be careful not to let patients who need it suffer needlessly.

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  • Imagine the drug lords delight if we truly clamp down on CDs! Oh boy oh boy oh boy! Prohibition baby!

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  • The underlying problem here is that optimal use (or non-use!) of opiates (for chronic non-fatal pathologies) involves the doc making a subjective judgement about a patient's pain and personality. These decisions can rarely be completely right or completely wrong.

    This balancing process is made more difficult by a "points mean prizes" benefits system that is seen as the only viable income option by some patients.

    Many GPs have been surprised over the years by the decisions made by many pain clinic consultants.

    I agree with most of the other commentators here. There are two main points being made:

    1) Starting a patient on potent opiates - or gabapentinoids - is infinitely easier than stopping them. (A point repeatedly denied by some proponents of some pain management strategies.)

    2) It seems rather unfair for one group of docs to undertaking the easy bit (starting!) and for another group of docs to have to cope with the task of trying to stop the stuff.

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  • So no opioids, no NSAIDs, no paracetamol... interesting conversations we are going to be left to have...

    Fortunately the fact there are virtually no alternative services available and any there are have a 12 month waiting list should make things even easier.

    Can we refuse to see all people with any pain issues at all and free up millions of pointless appointments and their MPs can sort them out in their monthly surgeries.

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  • It is crazy that we are allowed to prescribe these drugs when you see the abuse and harm we are causing.

    Make them all specialist only. End of problem.

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  • it does not take a specialist to start it, but certainly to stop it.

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