GPS need training to tackle chronic opioid use

GPs must be better-equipped to support patients to manage the psychological challenge of reducing their opioid use - according to research from the University of East Anglia.

The recommendation is part of a toolkit launched to help GPs reduce the amount of opioids they prescribe.

The toolkit outlines seven areas of best practice to tackle chronic opioid use – based on international research evidence, the experiences of health organisations and individual practitioners.

It comes after figures for England and Wales revealed an increase in opioid prescriptions of more than 60 per cent in a decade – from 14 million in 2008 to 23 million in 2018.

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.”

“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.”

Dr Bhattacharya said: “There needs to be a clear expectation that opioid de-prescribing is the responsibility of the prescriber.

“Incentives may help GPs and other health professionals to prioritise reducing the amount of opioids being prescribed to patients, particularly among those who have been taking them long-term.

“Prescribers need to better understand the consequences of excess opioid use, and they need better guidelines about how to gradually reduce or ‘taper’ doses.”

The ‘Toolkit for Tackling Chronic Opioid Use in Non-Cancer Pain’ has been supported by NIHR Collaboration for Leadership in Applied Health Research and Care East of England, hosted by Cambridgeshire and Peterborough NHS Foundation Trust.