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Shipman has made GPs wary of prescribing strong opioids

GPs lack support and advice on opioids, the

Pain Society's annual meeting

in Manchester earlier this

month was told – Rob Finch reports

Half of GPs lack the confidence to prescribe strong opioids for chronic pain because of clinical and legal uncertainties in the wake of the Shipman case, according to new research.

The situation has been made worse by a lack of support and advice to GPs, leading some to call for prescribing of the drugs to be initiated only in secondary care.

But pain specialists said this was not the way forward as patients would miss out on treatment that could be provided by the GP.

The study asked 41 GPs in Newcastle about their prescribing of opioids in chronic pain.

The results, presented earlier this month at the Pain Society's annual meeting in Manchester, showed about 50 per cent of GPs were concerned about prescribing strong opioids because of undesirable side-effects and risk of addiction or abuse.

Study co-author Dr Paul Wilkinson, a consultant in pain management at the Royal Victoria Infirmary, Newcastle upon Tyne, and a former GP said patients would 'miss out' if GPs stopped prescribing the drugs, especially in conditions such as chronic back pain.

Dr Graham Archard, RCGP spokesman on pain management and a GP in Christchurch, Dorset, said: 'GPs are split into two camps, one side are fairly confident in what they do, the other is concerned because of addiction and side effects, especially since Shipman. He has made people very concerned.'

Dr Archard said a move towards initiating prescribing of opioids in secondary care only would not help as GPs would still have to be responsible for follow-on prescriptions.

'When it comes to prescribing strong opioids for non-malignant pain, the patient should already have had care from a specialist – that would be the back-up,' he said.

Professor Richard Baker, professor of quality in health care at the University of Leicester, who led the review of Harold Shipman's clinical practice, said he thought GPs were justified in their concerns because support was 'patchy'.

He added: 'If there is good local advice, GPs will feel confident in prescribing controll-ed drugs.'

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