Opioid tool aims to help GPs have ‘challenging’ conversations

A new tool has been developed to help GPs assess patients’ use of opioids and identify any risks of dependence or unmanaged pain.
 
The Routine Opioid Outcome Monitoring (ROOM) system has been designed for use by patients, healthcare professionals and in general practice.
 
Developed by researchers at Monash University, led by Professor Suzanne Nielsen, ROOM showed significant improvements in confidence identifying and responding to unmanaged pain, depression and opioid dependence when used with 23 patients in New South Wales and Victoria.
 
The rate of opioid deaths in Australia, according to data from the AIHW, rose by 62% from 2007 to 2016, with prescription opioids more likely than heroin to be involved in deaths and hospitalisations.
 
Professor Nielsen said ROOM is the result of a ‘number of years of work recognising that opioids are essential but high-risk medicines’.
 
‘While assessing outcomes with opioids is recommended, it can actually be quite challenging,’ she said.
 
‘So, we set about trying to develop a tool that provided a really patient-centred way to start conversations around how a patient is going with their opioids.’
 
Sydney GP Dr Hester Wilson, Chair of RACGP Specific Interests Addiction Medicine, told newsGP around 20% of patients seen in general practice suffer chronic pain.
 
‘This can have a far-reaching negative impact on people’s lives,’ she said.
 
‘While opioids can sometimes be a useful, though small, part of management, they are associated with significant harms and best management involves active patient involvement with a focus on psychological, non-pharmacological and non-opioid medication options.’
 
Existing clinical tools aren’t always as suitable as ROOM for use in primary care, Professor Nielsen explains.
 
‘They are quite long and detailed,’ she said.
 
‘It became clear that we needed to look much more holistically at opioid outcomes.’
 
ROOM consists of 12 questions that can be completed by a patient in less than five minutes before or during an appointment, either on paper or online.
 
The development of ROOM also predicated a world-first brief screening tool for Opioid Use Disorder called the OWLS.
 
The OWLS measures four items of prescription opioid use: Overuse, Worrying, Losing interest, and feeling Slowed down, sluggish, or sedated.
 
The ROOM tool measures outcomes with opioids using a framework including pain, mood, opioid use disorder (using the OWLS), alcohol use and constipation.
 
With rules brought in by the Federal Government in 2020 requiring patients on long-term opioids to be assessed at least every 12 months, Professor Nielsen says ROOM can streamline this process into a GPs busy schedule.
 
‘We’ve seen that it’s acceptable for patients and GPs are telling us it works well with their practice,’ she said.
 
‘It will save GPs time by meeting their requirements and things that they need to document but in a way that’s patient-friendly, relatively straightforward and not overly bureaucratic.’
 
Dr Wilson said GPs can often find ‘conversations about changing the role of opioids in chronic pain with their patients conflictual and difficult’.
 
‘The ROOM tool is a validated patient reported measure that can help with this difficult conversation by helping patients to understand the wider impact of opioids on their physical and mental health and promote positive conversations that re-evaluate the role of opioids in their management,’ she said.
 
‘The 12-month PBS review is also a wonderful opportunity to assist in re-assessing the best management of opioids and chronic pain and the ROOM tool is a useful as part of this.’
 
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