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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.