Opioid Treatment for Non-Cancer Pain
Opioids are a group of strong painkillers and include codeine, tramadol, morphine, oxycodone, fentanyl, buprenorphine and methadone.
· There is evidence to suggest that opioids are very good painkillers when used for cancer pain, pain at the end of life or if used short term (for days to a few weeks) for some types of acute (i.e. recent onset) pain.
· Recent evidence has shown that opioids are poorly effective for long-term or chronic pain, which means pain that you have suffered for than 3 months.
As a result, opioid medication has been removed from a number of the guidelines that GPs use when treating chronic pain. For a small proportion of patients, opioids may be successfully used as part of a wider plan including non-medication treatments and self-management. If this is the case, best results are achieved when the opioids are used intermittently and at the lowest possible dose.
· When opioids are used, it is important to understand that the aim is not complete pain relief but rather reducing pain sufficiently to engage in self-management.
· The potential harms of opioid treatment include drowsiness (and in worst case scenario’s it can slow or stop your breathing resulting in death), nausea, constipation, effects on hormones, effects on the immune system, the potential for the drugs to worsen pain and the potential for problematic drug use and addiction.
· If the pain remains severe despite opioid treatment, it means that it is not working and should be stopped, even if no other treatment is available, as the risks outweigh the benefits.
The Oaks Medical Centre has a policy on prescribing of opiate medications as follows:
· All new opioids will be issued as acute prescriptions until all appropriate reviews are completed.
· All patients will need a review after 4 weeks of initiation of an opioid prescription; pain assessed, and a decision made as to the effectiveness of the drug.
· If opioids are ineffective, they will be stopped, even if no alternative is available.
· Where patients have been stabilised on an opioid which has been shown to be effective, this may be added to the patient’s repeat medication at the prescriber’s discretion.
· Patients on long-term opioids will be reviewed every 6 months to discuss slowly weaning off their opioid medication. Treatment will only be continued where there is clear on-going evidence of benefit.
· All opioids will be issued on prescriptions with a maximum duration of 1 month and we will not issue your prescription before it is due.
· All opioid prescriptions will include full directions wherever possible
· Where opioids are initiated by an external provider, the Practice will only take over prescribing once a written request has been received. Please be aware that if you are a new patient and your previous GP prescribed a medication such as an opioid with dependency forming potential, our prescriber’s will discuss with you if they feel that previous prescriptions were inappropriate and they will no longer continue to prescribe it for you.
Expectations of our patient’s prescribed opioid medication:
– You will not request your prescription early
– Your prescription will not be reissued if you misplace / lose your prescription
– You will not divert your prescribed medications to be used by anyone other than yourself
– Patients are reminded that we have a zero-tolerance policy on issues relating to staff verbal or physical abuse. We will not tolerate abusive demands for opioid medications.
Any threats to our staff will result in transfer of your care and you will be required to agree to the above before our clinical prescriber’s will issue you a prescription for an opioid medication.
Thank you for your understanding and co-operation with our policy.