We must tackle stigma around treating opioid-dependent patients: Rural GP

Wagga Wagga GP Dr Mary Ross told newsGP that not enough rural GPs are engaging in opioid treatment programs – despite the urgent need.
 
‘[GPs think] there’s a stigma to having drug seekers in the practice,’ she said. ‘But the great thing is once people are on methadone, they’re no longer drug-seeking and are much easier to handle.’
 
‘I see rewards for patients every day. Chaotic circumstances, criminal problems, parenting issues all improve and resolve when they’re on the methadone program.’
 
Rural and remote Australia are the areas worst hit by the prescription opioid epidemic. The rate of people being treated for morphine dependence in the bush is roughly double the major city rates, according to a 2016 study, ‘The extent and correlates of community-based pharmaceutical opioid utilisation in Australia,’ which covered the 2008–11 period.
 
The issue is compounded by a lack of specialist pain clinics, meaning GPs are at the frontline of dealing with both chronic pain and the challenge of people who become dependent on drugs prescribed to treat their pain.
 
Dr Ross, who runs a methadone service for around 70 patients, said more falls on a GPs’ shoulders in the country because other services often simply do not exist.
 
‘Abuse of prescribed opioids is higher in country areas, and access to medical services is an ongoing problem,’ she said.
 
The rural GP’s call for action comes after a May summit on medication-assisted treatment of opioid dependence recommended that a national training program be developed for GPs and pharmacists to tackle stigma in the treatment of opioid dependence.
 
Scriptwise Chair Dr Richard Kidd agrees that there is a historic stigma in the treatment of people who were opioid dependent.
 
‘There’s a perception that people who are opioid-dependent are on the wrong side of the tracks, in the drug scene,’ he told newsGP. ‘And that perception has somehow moved to opioid treatment for chronic pain, but it’s just not the case.’
 
Dr Kidd said the vast majority of people who are on opioid treatment programs became dependent through legal means.
 
‘I would strongly recommend that more GPs – not just rural, but in the city – get involved. It can be very satisfying to be involved in the opioid treatment journey, as many become free of the opioids and lead stable, productive lives,’ he said.
 
‘You’re enabling people to work through a condition that isn’t really their own fault. It might be a lack of education or supervision in the early days after they are given an opioid following surgery or an injury.
 
‘People in the bush probably don’t get as close a follow-up after they’re prescribed endone or another opioid and, in many cases, they’re keen to get back to work as quickly as they can.’
 
A 2006 study in the Australian Journal of Rural Health, ‘Chronic pain in the rural arena’, found that ‘many rural folk seek care only when symptoms become overwhelming because they could cope/complete their roles until then’, and suggested a link to many values rural people praise such as stoicism, independence and resilience.
 
‘Health is defined by many rural men as the ability to work, whereas rural women see health as the ability to adapt and cope,’ the researchers state.
 
The National Drug and Alcohol Research Centre has published a kit on medication-assisted treatment of opioid dependence, which Dr Ross describes as a vital resource.

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