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The waiting game

GP practice warns new patients they will not routinely prescribe opiates

A practice in Glasgow has warned prospective patients taking opioid medication that they will be expected to participate in a withdrawal programme upon registering.

The city's Springburn Health Centre has highlighted it does not 'routinely' prescribe nine opiates: diazepam, dihydrocodeine, gabapentin, morphine (or any of its alternatives), nitrazepam, tramadol, pregabalin, zopiclone/zolpidem and temazepam.

It has warned patients via a poster at its premises that anyone wishing to register with the practice who is taking the medication will have to sign up to a withdrawal programme.

The notice said: 'If you are taking any of the under noted medication, please be aware that we do not routinely prescribe these drugs at this practice. If you are joining our practice and are prescribed these drugs, we would be expecting you to engage in an appropriate withdrawal program.'

NHS Greater Glasgow and Clyde has clarified the health centre's approach is in line with national policy.

But the Scottish Drugs Forum, a membership-based policy organisation, has warned the sign appears to be 'discriminatory' against patients dependent on opioid prescriptions and patients who have opiate-based drug problems.

A spokesperson for the forum said: 'One of the distinguishing features of heroin use in Scotland is that it is overwhelmingly part of a polydrug use involving street benzodiazepines. In this context, it is hard to see this poster as anything other than discriminating against people with an opiate-based drug problem and an attempt to exclude this group of people from the practice.

'For people who have become dependent on medicines prescribed by the NHS, this is also discriminatory.'

They added: 'It is not unreasonable to suggest that people who have become dependent on drugs prescribed to them should receive better support than this. It is hard to see how this fits with a patient-centred approach, realistic medicine or any of several developments in models of good practice in service provision in Scotland.'

A spokesperson for NHS Greater Glasgow and Clyde said: ‘GPs routinely review the medicines prescribed to ensure they are still appropriate for the patient and are not causing harm. This is important when new patients join a GP practice.

‘These reviews may include reducing the daily dose of certain prescribed drugs or stopping them altogether in line with the chief medical officer’s realistic medicine policy.

‘It is widely recognised that this is a difficult area with GPs constantly having to weigh up risks of prescribed medication against the benefits of prescribing. Reviewing medicines in this way is consistent with guidance on prescribing set by the GMC which applies to all doctors and all GP practices.'

A BMA Scotland spokesperson said they would not comment on decisions made by an individual practice, but added: 'Of course, practices make decisions based on what their expertise indicates are the priorities of the areas they serve, within the context of services that are under severe pressure.

'GP’s work to clear protocols and guidelines when treating patients. It is vital that there are strong links between GP practices and drug and alcohol treatment services available within the communities they work. All treatment should be based on the clinical need of patients.'

Springburn Health Centre has been contacted for comment.

Meanwhile in England, GP opioid prescribing of gabapentin, pregabalin and oxycodone has ‘significantly’ increased in the last five years.

A recent review by Public Health England of addictive prescription medication - including opiods - found a quarter of adults had been prescribed at least one type in the past year, but officials also recognised the 'great pressure' GPs are under to provide access to these drugs.


Readers' comments (20)

  • We have been doing this for years - almost forced reductions as the evidence points to long term use not being beneficial

    We work with our local drug clinic and don’t prescribe any opiates at all.

    Have done random drug tests - and of negative means they are selling the medication and stop it

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  • Aren't GPs independent practitioners?
    Just because a new patient " claims" to be on opiates is there an automatic expectation that all previous scripts will continue to be prescribed.
    GPs are criticised for prescribing too much opiates and for no prescribing?!!

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  • Well I started practice with no patients hence drug addict were attracted to change doctor,
    In those days I always told patients , I will do every thing to help you but would not prescribe diconal or morphine.
    No one wanted to register .always thought it should be fully delt by specialist clinic,

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  • diconal, now there's a drug from the past. We used to call it the 'little pink darling' and patients with renal and biliary colic would have a few for emergencies. never had any addicts asking for it. It is one of those tablets where a drug company ramped up the price from a few pounds for 50 to many hundreds of pounds. Stopped using it then.

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  • Vinci Ho

    Well , the way this narrative of ‘prescription medicine killing people’ gaining momentum in US and UK( lesser degree) , something like this kind of exclusion, not necessarily discrimination, is inevitable. The argument held by GPs is that we are not equipped with the expertise with this undoubtedly , increasingly complex medical subject as the number of people on repeat prescription of opiates ( as well as benzodiazepines , z-drugs and gabapentinoids) is growing . If the government is never competent and helpful, GPs will have to protect themselves.

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  • As we had nothing else left ,every intractable
    Pain became neuropathic pain and gabapentin and pregabalin became escape rout for pain clinic, orthopaedic
    And gps followed expert advise. Now we have to pick up pieces.

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  • Interesting angle, playing the discrimination card. They are not refusing to register these patients, and are offering supervised gradual withdrawal of medications that are usually of no clinical benefit. I would feel that looking at the community as a whole, the benefits of this kind of approach far outweigh the downsides.

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  • Took Early Retirement

    Considering PULSE is a medical website, they really ought to know what an "Opiate is"!

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  • Well done the Springburn Health Centre. I hope that they stick to their guns.

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  • We're all paying the price for opiate Pharma companies' desired effect of their illegal hyping and marketing of their products, but we do need to be careful to avoid reflex pendulum overswing.

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