Pressure to ‘discharge patients quickly, to reduce waiting times in GP clinics and to cut outpatient services’ mean that prescribing pain relief medication has become a ‘quick fix’ for some doctors, GP and clinical lead for charity Action on Addiction Dr Simone Yule has said.
Many people who have suffered an accident, injury or major illness are being discharged from hospital with prescriptions for highly addictive pain relief without sufficient explanation of how such drugs should be used. In turn, they have an expectation that they need the medication and will be prescribed it until the pain stops, Dr Yule said.
‘We need to re-think our relationship with pain. That is, if we want to better manage substance abuse and avoid the opioid pandemic that is fast approaching the shores of the UK,’ Dr Yule said.
‘This is not one person’s fault. Not the surgeon, the GP, the patient, the outpatient care of the treatment centres, but every part of this chain needs to come together to create a healthy and holistic solution to pain management.’
'Whole system' approach
GPC clinical and prescribing policy lead Dr Andrew Green said: ‘Dr Yule’s perceptive comments illustrate many of the problems that the BMA has been highlighting since its landmark 2015 report. The BMA agrees that the use of opioid other drugs associated with dependence is a major public health problem and a "whole system" approach is needed to tackle this, which must include preventing patients starting these medications as much as helping them get off them.’
This systematic overhaul should include a change in the way prescriptions are managed in general practice, Dr Yule said. ‘GPs should improve methods for policing repeat prescriptions. In our surgery group we have strict monitoring of opioid prescriptions and we now have a warning on our computer, if anybody has been on a long-term prescription, for them to be reviewed.
‘I actually saw a patient recently who had previously suffered a major road traffic accident and was quite debilitated and on high dose opioids. It was highlighted that he was requesting more than he should be so I brought him in and in reality, it turned out, that he was desperate to get off medication but because he had not had the support from physiotherapy and the rehab service following his accident he had nowhere else to go other than to continue taking painkillers. Without a warning system it could have been many more months of repeat prescriptions before his desperate situation was clinically managed.’
Prescription drug addiction
Earlier this year, the government announced that Public Health England had been commissioned to launch a review into prescription drug addiction. According to the review, prescribing of addictive medicines increased 3% in five years and 7.6% of adults admitted to taking a prescription-only painkiller that had not been prescribed to them.
Speaking at the time, RCGP chair Professor Helen Stokes-Lampard said: 'Addiction to any substance can have a devastating impact on a patient’s health and wellbeing – and that of their family and friends. We welcome this independent review as a means of better understanding the complex reasons behind addiction to prescription medication, and to shape our approach to tackling it.
'We know most patients would rather not be on long-term medication and where appropriate we will explore non-pharmacological treatments, but these – and this is particularly so for psychological therapies - are often scarce at community-level.
'We hope that conclusions from this review will include highlighting the need for greater provision of and access to alternative treatments in the community – and for those patients who do become addicted to prescription medications to have easy, consistent, but also confidential access to appropriate, high-quality support.'
Public health minister Steve Brine said: ‘We know this is a huge problem in other countries like the United States—and we must absolutely make sure it doesn’t become one here. While we are world-leading in offering free treatment for addiction, we cannot be complacent—that’s why I’ve asked PHE to conduct this review.
‘PHE has an excellent track record in robust evidence reviews, and this will help us understand the scale of this issue here and how we can address it.’
Other areas Dr Yule highlighted as needing improvement were drug education, access to physical rehabilitation and the de-stigmatisation of treatment centres.