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One-to-one GP pain service helped patients cut opioid use, finds small study

A one-to-one pain service based in general practice was successful in reducing opioid use in 40% of patients, cutting GP consultations and improving health and wellbeing, a small analysis has shown.

The researchers said that, of the 34 patients who had taken part in the pilot scheme across two general practices, three had stopped taking opioids altogether.

Writing in the British Journal of General Practice they concluded that it showed there is potential for patients dependent on opioids for long-term chronic pain to be managed in primary care and called for a randomised controlled trial to test the service on a larger scale.

In September a long-awaited report from Public Health England concluded that one in four adults were prescribed addictive drugs between 2017 and 2018 and called for more support services to help GPs and patients manage withdrawal in the community.

Commissioners are encouraged to provide treatment and support for patients addicted to opioids but it is not clear which interventions are the most effective, the researchers pointed out.

GPs say they often have nowhere to refer patients who are dependent on painkillers.

The pain service, based in South Gloucestershire, used project workers based in general practice to provide individually tailored advice on pain management.

Of the 34 patients assessed for the study, the majority had been taking prescription opioids for more than five years, most commonly for back pain, and nine patients had been taking them for at least 15 years.

The median prescribed opioid dose reduced from 90 mg (range of 60 to 240mg) at baseline to 72 mg (range of 30 to 160) at follow-up. In all, 15 patients reduced their dose (44.1%), three stopped taking them altogether and 19 stayed on the same dose (55.9%).

In addition, the number of patients deemed to be misusing opioids fell from 85.7% 5o 68.2%.

The researchers also reported improvements on a range of health, wellbeing and quality of life scores.

Interviews with GPs whose patients had taken part in the scheme said there had been fewer consultations with ‘high demand’ patients.

Study leader Dr Kyla Thomas, a consultant senior lecturer in public health medicine at the University of Bristol said: ‘We welcome the recommendation in Public Health England’s prescribed medicines review related to improving the support available from the healthcare system for these patients.

‘We agree that the NHS locally should work with local authorities to commission support for these patients, to develop a response that is informed by local needs and circumstances, and involves local primary care services, pain and addiction specialists and patient groups.’

Dr Krishna Kasaraneni, GPC executive team member at the BMA, said: ‘It’s important that patients affected by prescribed drug dependence have access to the care and support they need, and the BMA has been working with stakeholders for some time now to identify ways to do this.

‘As part of this, we welcomed Public Health England’s review earlier this year, which recommended the need for a national helpline and commissioned support, as well as evaluations of existing services of the type examined in this study.’



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