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Opioid crisis in primary care? An audit of high-dose opioid prescribing at Bangholm GP Practice.
Br J Gen Pract. 2020 Jun; 70(suppl 1)BJ

Abstract

BACKGROUND

Opioids are effective analgesics for acute and palliative pain, but there is no evidence base for long-term pain relief. They also carry considerable risks such as overdose and dependence. Despite this, they are increasingly prescribed for chronic pain. In the UK, opioid prescribing more than doubled between 1998 and 2018.

AIM

An audit at Bangholm GP Practice to understand the scale of high-strength opioid prescribing. The aim of the audit was to find out if indications, length of prescription, discussion, and documentation at initial consultation and review process were consistent with best-practice guidelines.

METHOD

A search on Scottish Therapeutics Utility for patients prescribed an average daily dose of opioid equivalent ≥50 mg morphine between 1 July 2019 and 1 October 2019, excluding methadone, cancer pain, or palliative prescriptions. The Faculty of Pain Medicine's best-practice guidelines were used.

RESULTS

Demographics: 60 patients (37 females), average age 62, 28% registered with repeat opioid prescription, 38% comorbid depression. Length of prescription: average 6 years, 57% >5 years, 22% >10 years. Opioid: 52% tramadol, 23% on two opioids.

INDICATIONS

back pain (42%), osteoarthritis (12%), fibromyalgia (10%). Initial consultation: 7% agreed outcomes, 35% follow-up documented.

REVIEW

56% 4-week, 70% past year.

CONCLUSION

Opioid prescribing guidelines are not followed. The significant issues are: long-term prescriptions for chronic pain, especially back pain; new patients registering with repeat prescriptions; and no outcomes of treatment agreed, a crucial message is the goal is pain management rather than relief. Changes have been introduced at the practice: a patient information sheet, compulsory 1-month review for new patients on opioids, and in-surgery pain referrals.

Authors+Show Affiliations

King's College London, GKT School of Medicine.King's College London, GKT School of Medicine.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32554680

Citation

Greene, Charlotte, and Alice Pearson. "Opioid Crisis in Primary Care? an Audit of High-dose Opioid Prescribing at Bangholm GP Practice." The British Journal of General Practice : the Journal of the Royal College of General Practitioners, vol. 70, no. suppl 1, 2020.
Greene C, Pearson A. Opioid crisis in primary care? An audit of high-dose opioid prescribing at Bangholm GP Practice. Br J Gen Pract. 2020;70(suppl 1).
Greene, C., & Pearson, A. (2020). Opioid crisis in primary care? An audit of high-dose opioid prescribing at Bangholm GP Practice. The British Journal of General Practice : the Journal of the Royal College of General Practitioners, 70(suppl 1). https://doi.org/10.3399/bjgp20X711581
Greene C, Pearson A. Opioid Crisis in Primary Care? an Audit of High-dose Opioid Prescribing at Bangholm GP Practice. Br J Gen Pract. 2020;70(suppl 1) PubMed PMID: 32554680.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Opioid crisis in primary care? An audit of high-dose opioid prescribing at Bangholm GP Practice. AU - Greene,Charlotte, AU - Pearson,Alice, PY - 2020/6/20/entrez PY - 2020/6/20/pubmed PY - 2020/6/20/medline JF - The British journal of general practice : the journal of the Royal College of General Practitioners JO - Br J Gen Pract VL - 70 IS - suppl 1 N2 - BACKGROUND: Opioids are effective analgesics for acute and palliative pain, but there is no evidence base for long-term pain relief. They also carry considerable risks such as overdose and dependence. Despite this, they are increasingly prescribed for chronic pain. In the UK, opioid prescribing more than doubled between 1998 and 2018. AIM: An audit at Bangholm GP Practice to understand the scale of high-strength opioid prescribing. The aim of the audit was to find out if indications, length of prescription, discussion, and documentation at initial consultation and review process were consistent with best-practice guidelines. METHOD: A search on Scottish Therapeutics Utility for patients prescribed an average daily dose of opioid equivalent ≥50 mg morphine between 1 July 2019 and 1 October 2019, excluding methadone, cancer pain, or palliative prescriptions. The Faculty of Pain Medicine's best-practice guidelines were used. RESULTS: Demographics: 60 patients (37 females), average age 62, 28% registered with repeat opioid prescription, 38% comorbid depression. Length of prescription: average 6 years, 57% >5 years, 22% >10 years. Opioid: 52% tramadol, 23% on two opioids. INDICATIONS: back pain (42%), osteoarthritis (12%), fibromyalgia (10%). Initial consultation: 7% agreed outcomes, 35% follow-up documented. REVIEW: 56% 4-week, 70% past year. CONCLUSION: Opioid prescribing guidelines are not followed. The significant issues are: long-term prescriptions for chronic pain, especially back pain; new patients registering with repeat prescriptions; and no outcomes of treatment agreed, a crucial message is the goal is pain management rather than relief. Changes have been introduced at the practice: a patient information sheet, compulsory 1-month review for new patients on opioids, and in-surgery pain referrals. SN - 1478-5242 UR - https://www.unboundmedicine.com/medline/citation/32554680/Opioid_crisis_in_primary_care_An_audit_of_high-dose_opioid_prescribing_at_Bangholm_GP_Practice L2 - https://bjgp.org/cgi/pmidlookup?view=long&pmid=32554680 DB - PRIME DP - Unbound Medicine ER -
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