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GPs should do 'early reviews' of patients newly prescribed opioids

GPs should do early reviews of anyone newly prescribed medication such as codeine, morphine and tramadol and ongoing annual follow ups as a minimum, new guidelines have said.

SIGN recommendations on chronic pain management have been updated to reflect growing concerns around addiction to prescribed opioid treatment.

The recommendations state that opioids should only be considered for short- to medium-term pain relief when other treatments have not worked and the benefits outweigh serious harms such as ‘addiction, overdose and death’.

When reviewing patients, doctors should look for signs of abuse, addiction or harm, the guidelines state.

The opioid section of the guidelines, originally published in 2013, has been updated in response to a significant increase in their prescription despite limited evidence of effectiveness.

Figures for Scotland for 2018/19 show 2,679,182 prescriptions for opioids dispensed at a cost of around £29m.

Health Improvement Scotland said the recommendation has been made to help protect patients from addiction and overdose, plus other side effects such as increased risk of falls.

A Public Health England review into prescription drug addiction, including opioids, is due to be published this summer.

GPs had previously told Pulse that there were a lack of specialist services for patients addicted to prescribed medication and investment would be needed if progress is to be made.

Professor Lesley Colvin, co-chair of the SIGN Guideline Development Group and professor of pain medicine at the University of Dundee, said the purpose of the review had been to ensure that those who benefit from opioids for chronic pain continue to get the relief they need, but are also protected from potential harmful effects and new evidence had been taken into account.

'Opioids should only be started after careful assessment and discussion, with agreement that benefits must outweigh risks for continuing use.

'“The best evidence tells us that better management of opioid prescribing, alongside consideration of other management strategies – such as supporting increased physical activity – with increased reviewing of patients, will give patients the protection they need.'

Readers' comments (6)

  • Quite why anyone is prescribing opioids for more than a week or two, outside of drug addiction services, is a mystery.

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  • David Banner

    (Re Stelvio - just how do you keep the codeine craving crowd away? Your surgery must be like Rorke’s Drift! Seriously, any handy hints would be welcomed...)

    Talk about door locking/bolted horse! First they batter us with WHO guidelines lambasting GPs for withholding strong opiates in the late 20th century, then push the strongest opiates and gabapentinoids on to willing patients via Pain Clinics, and finally (when the true horror of this catastrophic short term thinking unfolds) start lambasting the hapless GPs AGAIN for reckless/feckless prescribing!

    As anyone who has ever embarked upon the thankless futile task of withdrawing an unwilling codeine/tramadol/pregabalin “addict” will testify, this is a useless Sisyphean task. Within weeks Dr B has put them back on the same stuff.

    A whole new approach is needed....

    - ban initiation of CDs for chronic pain in Primary Care
    - If Secondary Care initiate CDs, they must keep patients on their books (under a Shared Care scheme) until they have withdrawn.
    - stop A&E and surgeons recklessly discharging people with bottles of Oramorph!
    - and for the huge number poor wretches already hopelessly hooked on the stuff, properly funded structured withdrawal clinics in the community (yeah, I know, flying pigs and all that)

    But if (as we all suspect) the recommendations simply amount to GP bashing and blaming (with lots of league tables to name and shame the worst offenders splashed across the local rag) then this slow moving disaster will continue ad nauseum.

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  • David I completely agree. Thank god for GPs with real word experience and no cardigan

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  • David has hit the nail on the head ... Those at the coal face understand the catch 22 of opioid prescribing .....try dealing with reattending " it's inhumane to leave me in pain" patients to such guidance, pain clinics just add to the problem at times.

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  • totally agree with DB. currently weaning loads of patients addicted to CDs. the abuse and complaints are endless but worth it in the end when you have a human being reappear from the fog of opiods and benzos. Don't prescribe them now unless forced to do so and I tell patients exactly why I don't like prescribing them, not to drive on them as they could lose their licence if caught dangerous driving on them, this really does happen, never take with alcohol, can cause sudden respiratory depression and death in combinations - amazing how many people don't want them after that.

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  • DrRubbishBin

    Beng blunt about the risks of addiction, driving impairment, constipation, lack of efficacy in chronic atypical pain etc etc will work with some people, but won't work on those who lack a functioning frontal cortex (be that because they don't have one, or the bit that they do is iatrogenicaly? glued up) it takes time, emotional energy, perseverance and continuity. It's sad when on occasion you find don't happen to have all these things on you.

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