Prescribing of opioid painkillers such as tramadol and codeine for long-term pain has increased dramatically in the UK in recent years, along with the number of opioid-related deaths. Public health authorities in the US, where over 100 people die every day from opioid-related causes, have declared an opioid emergency.
Now a new GP service in South Gloucestershire offers the promise of dealing effectively with long-term opioid prescribing and dependency.
Project workers, attached to two practices, identified patients on prescription opioids and enrolled them into a structured programme, beginning with an understanding of their pain control needs and the creation of individual pain management plans. Subsequent sessions concentrated on education, medication review, pain management strategies and goal setting, supported by input from services such as physiotherapy, CBT, relaxation and mindfulness, and non-medical pain management strategies, in which tasks are broken into manageable units.1
Patients welcomed the chance to have time to discuss their pain, its management and related psychological issues, but the GPs involved say that funding is needed to ensure they have time to support a similar service, and to ensure that project workers receive adequate clinical supervision.2
Commenting on the research in the British Journal of General Practice, Dr Debi Bhattacharya, who helped develop a toolkit to help reduce opioid prescribing, said: ‘Opioids, like morphine, tramadol and fentanyl, can be effective for the short-term management of severe pain. However, they are highly addictive which makes stopping difficult yet long-term use can impair quality of life and overuse can be deadly.’
Dr Bharracharya, of the University of East Anglia’s School of Pharmacy added: ‘Health professionals need to urgently, proactively work with patients prescribed long-term opioids for non-cancer pain to gradually reduce or “taper” their doses.
‘Reports of this new service are incredibly encouraging.’
1. Scott LJ, et al. Br J Gen Pract 2019 https://bjgp.org/content/early/2019/10/07/bjgp19X706097; 2. Kesten J, et al. Br J Gen Pract 2019 https://doi.org/10.3399/bjgp19X707237