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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.’