Figures for England and Wales show a 10-year increase of more than 60% in opioid prescriptions - from 14m in 2008 to 23m in 2018. The RCGP warned earlier this year that the UK was heading for a ‘US-style crisis’ and called for ‘more clinical guidelines’ on opioid prescribing for primary care.
Researchers at the University of East Anglia (UEA) have developed a ‘toolkit for tackling chronic opioid use in non-cancer pain’ to help GPs and other healthcare professionals reduce their opioid prescribing.
After reviewing 56 peer-reviewed studies and 21 pieces of literature, UEA researchers concluded that ‘there needs to be a clear expectation that opioid de-prescribing is the responsibility of prescribers’. But they warned that GPs needed more support and training to tackle the crisis.
Opioid tapering toolkit
Lead researcher Dr Debi Bhattacharya, from UEA’s School of Pharmacy, 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.
‘GPs and other health professionals need to urgently, proactively work with patients prescribed long-term opioids for non-cancer pain to gradually reduce or "taper" their doses. But if GPs are expected to initiate discussions about tapering or stopping opioids, they must be equipped with training to manage the psychological challenges experienced by patients when trying to reduce their opioid use.’
Based on the results gathered by Dr Bhattacharya and her team, the toolkit outlines several key features to be included ‘in all opioid deprescribing interventions.’ It states that all programmes should include:
- Information about the consequences of excess opioid use. This could be distributed to patients in the form of a document or webpage.
- Information about how to taper. The toolkit gives examples of ‘materials provided by reputable organisations’ and concludes that ‘the guidelines that allowed for tailoring were more successful.
- Prescribers with appropriate knowledge and skills to initiate tapering discussions and navigate the patient pathway. The toolkit states that ‘effective interventions included delivery by practitioners with the skills to initiate and manage discussions related to negative thoughts and feelings about opioid tapering.’
- A consistent approach by all members of the healthcare team ‘within and between care settings’ when it comes to interventions and tapering strategy.
- Comprehensive education for patients. The researchers note that ‘a wide range of patient education materials are freely available’ and gives examples.
- A pathway for patient management. This includes ‘access to appropriate levels of psychological and physical support’. Bespoke pathways should be developed ‘involving all relevant stakeholders to address specific local needs and resource.’
Dr Bhattacharya added: ‘Without this training, prescribers are reticent to open a "can of worms" that they know they don't have the skills to manage. For opioid tapering interventions to be effective, GPs need training in giving their patients the skills to manage any withdrawal effects.’
This comes less than a year after top GP and clinical lead for charity Action on Addiction Dr Simone Yule told GPonline that workload pressures in primary care were responsible for driving the UK towards an ‘opioid pandemic’.
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, 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,’ she added.
‘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.’
Speaking at the time, GPC clinical and prescribing lead Dr Andrew Green said: ‘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.’