RACGP 12-point opioid challenge

Paul Hayes

30/10/2017 12:00:00 AM

With the issue of pain management becoming increasingly prevalent in Australian healthcare, GPs are often at the forefront of dealing with patients experiencing chronic non-cancer pain. However, the role of opioids in treating these patients has raised increasing concerns about safety.
‘For many people, good pain management can transform their quality of life,’ RACGP President Dr Bastian Seidel said. ‘Unfortunately, what we have been seeing is an exploitation of painkilling medications.’

Reducing opioid prescribing in general practice: 12-point challenge to GPs
Reducing opioid prescribing in general practice: 12-point challenge to GPs

Dr Evan Ackermann, lead author of the RACGP’s Prescribing drugs of dependence in general practice, has issued general practice with a 12-point challenge aimed at reducing opioid prescribing.

He encourages all GPs to undertake the challenge, which aligns with the recent launch of the latest part of Prescribing drugs of dependence in general practice – Part C1: Opioids and Part C2: The role of opioids in pain management.

Reducing opioid prescribing in general practice: 12-point challenge to GPs

For acute pain:

  • Know when non-opioid analgesics are preferred for acute pain in general practice. For example, headache, dysmenorrhoea, dental pains, minor musculoskeletal strains/sprains.
  • Engage a physiotherapist early in more severe acute musculoskeletal injuries.
  • Prioritise non-opioid options for people who have been on long-term low-dose codeine preparations.
  • If opioids are necessary for severe acute pain, limit prescription to three days’ supply.
  • On discharge from hospital, discuss early tapering of opioids as part of recovery process.
For chronic non-cancer pain:
  • Maximise non-opioid therapies and multidisciplinary care in chronic pain.
  • Avoid opioids for chronic non-cancer pain in patients with an active or past substance-use disorder or unstable psychiatric disorder.
  • Where opioid therapy is necessary, ascertain responsiveness below 50 mg morphine-equivalent dose per day and seek assistance well before 100 mg morphine-equivalent dose per day is reached.
  • Reassess opioid-responsiveness regularly and often; have an agreed practice system for the 12-month structured review of opioid therapy.
  • Undertake intermittent planned reductions of opioid dosage in chronic non-cancer pain management.
  • Avoid fentanyl patches for non-cancer pain.
  • Where existing patients are on >100 mg morphine-equivalent dose per day for chronic non-cancer pain, trial tapering this dose to more appropriate levels.
Join the pain management discussion led by Dr Ackermann in shareGP.

opioids pain painkillers pain-management

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Julie Ackroyd   24/07/2018 9:15:32 PM

Extremely disappointed in the reaction from our GP in response to this issue. My mum has been a patient of our GP for over 35 years and has a significant medical history. The only opioid medication my mum requests is Panadeine Forte and the GP now refuses to prescribe them as he has had this letter and is now concerned about his registration. She was advised to get another Dr to prescribe the pain medication. Where is quality health care or rights for patients. Absolutely disgusted.

Gary   3/11/2018 12:06:09 AM

I know how you feel we are the ones who have to suffer because of so people over prescribing or stupid people overdosing why do people who do the right thing get dragged into the mix. I have been on opioid medication for pain from the age of 15 and am now 43 with no issues I am dependant on the crap and have tried to go off many times but the pain become too much to put up with I have gone from the equivalent of 675mg of morphine a day and am on targen 40/20 and have been for the last 3 years today I went to get a script the same doctor I have seen for 3 to 4 months asked me why I am on this medication for and gives me a form that reads like I am a drug addict is this standard practice? Has there been a change in legislation? because I can't find it and that is how I ended up here.

John Galatis   14/11/2021 1:37:47 AM

It’s always the way . I have ruptured discs in my lower back . Siatica down my legs. The same in my neck and near total loss of disc space in my lower neck . I have always staid in pain until I had to resort to pain killers. I was taking panadien forte, as I didn’t want anything stronger. I’m now as I feel punished for trying not to take a lot of overly strong drugs. How could this be a responsible that my doctor can stop , and give me anti inflammatory pills that don’t stop acute pain. Which also take around two weeks to work, which also can cause stomache ulcers or bleeding from long term use. Which enevebly lead to more drugs to counter act that. Circle of drugs