NICE has produced new guidelines to tackle GPs’ reluctance to prescribe opioids as part of palliative care.
The institute said it had launched the guidelines as evidence suggested pain from advanced disease, including cancer or heart failure, remained under-treated, and that patients can be ‘opioid-naïve’.
The guidelines suggest GPs talk to patients about common concerns such as addiction, tolerance, side effects and fears that treatment implies they are in the final stages of their life. It advises GPs to give advice on managing common side-effects like constipation, nausea and drowsiness.
GPs are advised to provide verbal and written information explaining when and why strong opioids are used to treat pain, how effective they are likely to be, what side effects and signs of toxicity to expect, where to store the drugs, information on follow up and further prescribing, and information on who to contact out of hours.
Offering patients access to frequent review of pain control and adjusting the dose until a good balance exists between acceptable pain control and side effects were also recommended.
Professor Mark Baker, director of the Centre for Clinical Practice at NICE, said: ‘Many people with chronic or advanced conditions will experience a high level of pain which can only be treated by opioids such as morphine as weaker forms of pain relief will no longer be effective.
‘However, we understand that patients can be anxious about using these medicines for a number of reasons. Likewise, healthcare professionals may not always be sure about when to prescribe certain types of opioids.’
Dr Sunil Sapre, a GP in Liverpool, said that the release of the guidelines will give support to GPs that might have previously been reluctant to prescribe opioids.
He said: ‘We are glad they have come out. It was overdue. If it’s a terminal patient there should be no fear. The guidelines will reassure patients and GPs they don’t have to worry if something official is out.’