Long-term use of opioids should be curbed with “rational prescribing” used to cut down consumption, according to the Scottish Government’s lead clinician on chronic pain. Professor Blair Smith, who lectures at the University of Dundee, believes rational prescribing should be widely adopted, with GPs and other prescribers agreeing with patients what the goals of taking the drugs are.
Professor Smith worked with colleagues in other universities on research published this year that explored the rates of opioid prescribing in Scotland. The team looked at every prescription for opioid medicine dispensed across the country between 2003 and 2012. They discovered that the number of prescriptions of “strong” opioids including fentanyl – which killed music legend Prince – morphine, oxycodone and others more than doubled from 474,385 to 1,036,446 a year. A total of 18 per cent of people in Scotland received at least one opioid prescription.
Women were more likely to receive a “weak” opioid (such as codeine or tramadol) but there was no gender difference in the prescription of strong opioids. There were four times more prescriptions for strong opioids dispensed to people in the most deprived areas than to those in the most affluent areas. Smith said: “We’re looking to support prescribers in what we would call rational prescribing with the aim being that before you even consider an opioid prescription you first of all agree with the patient what the goals of prescription are.
“They [prescribers] were using it as a basis to increase function and quality of life rather than to kill pain because in the long-term they don’t get rid of pain. It’s agreeing when to try a medicine for which there is evidence that it might be effective in this individual’s particular circumstance and agreeing what you’re trying to achieve by starting that medicine and that’s unlikely to be complete relief of pain.” He added: “I suspect that often prescription continues because there isn’t time for an adequate review, but I wouldn’t like to blame individual GPs.
“Unless anything else happens to the patient the prescription is continued and continued – so there is a responsibility for prescribers to consider the appropriateness of ongoing opioid prescription and very often there’s considerable pressure from the patient to continue the prescription.” Smith said that at the moment there is a lack of evidence to support non-pharmacological pain management, although it is “likely to be much safer and at least effective” and is calling for more investment into research around non-drug treatment. The Scottish Drugs Forum campaign group launched an initiative to highlight alternatives to opioid prescribing on Thursday as concerns grow that overuse is contributing to record drugs death figures. The number of drug-related deaths in Scotland rose to a record 934 in 2017, with opioids such as heroin and morphine linked to 87 per cent of the deaths. The Scottish Government is reviewing the guidelines for prescribing high-strength painkillers with a report due next year.