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Plans for GPs to annually review patients prescribed opioids under discussion



Exclusive The BMA and the RCGP are driving plans to review the use of opioids, which could see GPs conducting annual reviews on patients on strong painkillers.

Pulse has learnt that the BMA has written to health ministers calling for an inquiry into drug dependency.

At the same time, the RCGP’s lead for pain has been in discussions with MPs around his proposals for GPs to conduct annual reviews.

Recent data has shown that prescriptions of opioids has massively increased over the past decade, from around 13 million items in 2005 to 27 million items in 2015.

Critics argue there is limited evidence that opioids are effective in chronic pain and the risk of dependency and adverse effects is well documented, and NICE’s latest guideline on back pain advises GPs not to offer opioids such as tramadol routinely for acute low back pain.

RCGP clinical lead on chronic pain Dr Martin Johnson said he is in ‘high-level’ talks with the All Party Parliamentary Group (APPG) on drug dependency around GPs doing annual reviews for all chronic pain patients on opioid drugs – proposal he outlined in a 2015 report from the Chronic Pain Policy Coalition, which he chairs.

He told Pulse: ‘There have been several recent reports on dependency, which raise some good questions, but the issue needs to be addressed at the next level up, with government. So, we’re preparing a high-level inquiry.’

Harry Shapiro, director of online advice site Drugwise.org and spokesperson for the APPG, told Pulse the group would ‘absolutely’ support ongoing monitoring of patients’ opioid use.

Meanwhile, a BMA spokesperson told Pulse: ‘We have asked the [Commons’ health] select committee to hold an inquiry into prescribed drug dependence. We had written to former minister for health Nicola Blackwood to discuss this.’

Dr Steve Brinksman, a GPSI in pain in Birmingham and clinical lead for the Substance Misuse Management in Group Practice network, said: ‘The problem is opioids work for less than 20% of people with chronic pain but 80% of prescriptions that get started don’t get stopped.’

However, the BMA GP Committee’s prescribing lead, Dr Andrew Green, said: ‘Individual patient circumstances vary so greatly it is unusual for a specific review interval to be appropriate to everyone.’

He added GPs need more resources if there is to be a change in prescribing patterns.