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GPs should keep record of patients with high use of opioids, say researchers

GPs should add data to a national register of patients with high use of opioids, researchers have suggested.

The recommendation follows a study finding that there was an overall increase in opioid prescribing in England between 2010 and 2014.

The researchers, from University College London and the London School of Hygiene and Tropical Medicine, further found that more opioids were prescribed in the north than in the south of England, and that more opioids were prescribed in areas of greater social deprivation.

The retrospective observational study was based on publicly available primary care prescribing data (August 2010-February 2014) and indices of social deprivation.

The researchers evaluated prescribing of eight opioid drugs and their total morphine equivalent, identifying 'an overall increase... specifically of buprenorphine, codeine, morphine, oxycodone, and tramadol', with tramadol identified as  the most prescribed.

The paper, published in the BJGP, said the findings come despite opioids having ‘poor efficacy for non-cancer pain, potential harm and incompatibility with best practice’.

The paper said: ‘This study exposes increasing rates of prescription of a class of drugs whose use for chronic pain is controversial, with potential for abuse, and an association with serious adverse effects and premature death.

‘The authors call on policymakers to identify the reasons for this variation to enable avoidable harm to be addressed.’

They added that this comes as ‘specialist pain service infrastructure lacks capacity’ with ‘as few as one in five people with problematic pain’ gaining access to the services.

The researchers concluded that ‘a national registry of patients with high opioid use would improve patient safety for this high-risk demographic, as well as provide more focused epidemiological data regarding patterns of prescribing’.

‘The profile of chronic pain has been raised substantially in the last few years and good practice needs now to extend from specialist to primary care,’ the paper said.

RCGP chair Professor Helen Stokes-Lampard said: ‘Addiction to any substance can have a potentially life-changing effect on a person’s health and wellbeing, which is why GPs will carefully consider the risks of a drug before prescribing it to a patient…

‘However, most patients don’t want to be on long-term prescriptions and, where possible, GPs will always try to explore non-pharmacological treatments – but these are often hard to come by at a community level, leaving family doctors with few alternatives that are still of equal benefit to the patient.’

She added that GPs and their teams should encourage patients to attend regular medication reviews and ensure the drugs were ‘only prescribed for the shortest amount of time’.

The paper comes as Public Health England has been tasked with carrying out a major review of prescription drug addiction which includes opioid pain medicines as well as benzodiazepines, z-drugs, gabapentinoids and antidepressants.

Readers' comments (4)

  • David Banner

    “Good practice needs to extend from secondary to primary care”
    Have they ever read a Pain Clinic discharge letter??
    “Dear GP, I’m discharging this obese lady with back pain after 1 consultation. Please start her on oxycodone then titrate up, and if that doesn’t work bang her on pregabalin. Your problem now, matey, ciao!!”
    I’m sure there’s a lot to learn from such “good practice”
    And as for weaning them off these “short term” drugs for CHRONIC pain (the clue’s in the name, geniuses), well it’s fortunate we have such a surplus of GPs with acres of empty appointments to perform these monthly med reviews.
    So as expected, the new guidelines on these drugs will be a GP witch hunt. Cheers.

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  • 'a national registry of patients with high opioid use'

    Classic statist research conclusion. Can't think of any way such a list would be a bad thing, nope no potential problems at all.

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  • What a load of bollocks. We already have a record

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  • I know BS when I see it. All medication issued is recorded. Clearly someone out of touch out of practice has raised this non issue.

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