Managing addiction to prescribed opioids: the job of general practice?

Abstract

There have been increasing concerns about the potential harms of prescribed opioid drugs, their ability to cause inadvertent dependence, and worries about their lack of effectiveness for managing chronic pain.1–5 Prescription opioid medication has been found to be a significant and increasing cause of death from accidental and intentional drug poisoning.6 This article discusses five important questions: the extent to which opioid analgesics are prescribed, their costs and consequences, what benefits they give for chronic pain, what treatment is effective in helping patients with dependent use, and whether this can be provided in a primary care setting. Bolton, a district in Greater Manchester with a population of 280 400, spent just under £2 million on 148 000 prescriptions of opioid drugs during the financial year 2016/2017 (Bhaiyat H, health information analyst, Bolton CCG PACT data 2018). On average this is a prescription for every two people per year. For many this was repeated prescribing. There is considerable variation in opioid prescribing. A study of the duration and potency of opioid analgesic prescribing in general practices in Leeds and Bradford to patients without cancer found an association between higher potency of drugs and longer …