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Weaning plans at heart of new opioid care standard


Jolyon Attwooll


27/04/2022 4:42:36 PM

The guidelines, the first national clinical care standard for prescription opioid use in acute care, are designed to minimise the risks of harm.

Man suffering, with opioid bottles in foreground
The document sets out the best way to manage pain, while reducing the risks of opioid prescription.

The first national clinical care standard on opioid use in acute care was launched this week – and those behind believe it will help GPs protect patients from the risks of opioid dependency.
 
Professor Anne Duggan is the Chief Medical Officer of the Australian Commission on Safety and Quality in Health Care (ACSQHC), which developed the Opioid Analgesic Stewardship in Acute Pain Clinical Care Standard.
 
‘I would hope it makes life easier [for GPs],’ Professor Duggan told newsGP.
 
‘This is the first time we’ve had a national approach to the management of opioids in the acute care setting. It also has implications for primary care because [for] all patients [who] leave hospital, there should be good transition of care.’
 
The guidelines stress the importance of a weaning and cessation plans for patients when opioids are prescribed.
 
‘GPs should be expecting very good high-quality discharge summaries from hospitals telling them what’s been happening with the patient and recommending a weaning program,’ Professor Duggan said.
 
The ACSQHC was asked to put together clinical care guidelines to support regulatory changes, which were introduced due to growing concerns over the damage caused by prescription opioids.
 
According to the most recent data published by the Australian Institute of Health and Welfare (AIHW), there are almost 150 daily hospitalisations and 14 emergency department admissions involving opioid harm. Three people on average die from drug-induced deaths involving opioid use each day, according to the 2018 statistics.
 
Another AIHW report from the same year suggested more than three million people received at least one prescription each year for opioids.

As well as promoting non-opioid alternatives to pain management, the preferred use of immediate-release opioids is also stressed in the clinical care standard.
 
‘Current guidelines and advice support the use of immediate-release opioid analgesics for short-term use in acute pain at the lowest dose, for the shortest duration to minimise harm associated with opioid analgesics,’ the document states.
 
‘There is no evidence to support the use of modified-release opioid analgesics for acute pain, and evidence is emerging that suggests that their use is problematic.’
 
Dr Hester Wilson, Chair of RACGP Specific Interests Addiction Medicine, was involved in the development of the guidelines.
 
‘The important thing for us is around that safe and appropriate transfer of care,’ she told newsGP.

Dr Wilson says many GPs will have experienced situations with patients who have been in acute care requesting further medication without discharge summaries.
 
‘We don’t have any background … to really start to have that conversation around what’s most appropriate,’ Dr Wilson said.
 
‘It’s about having a really well worked out plan that takes into account the risks that we know exist around opioids and opioid prescribing, and the fact that sometimes in the past when people have come out of hospital, they’ve stayed on their opioids far too long.
 
‘That’s an issue for us trying to manage that in general practice.’
 
Professor Duggan says the clinical care standards are particularly relevant to GPs in rural and remote areas who are more likely to be involved in acute care for their patients.
 
‘From the general practice perspective, I recognise outside metropolitan areas many GPs are managing their patients in hospitals, so this supports better assessment of patients and consideration of other medications they’re on,’ she said.
 
The clinical standards are not designed to deprive people of access to opioids, Professor Duggan says, but rather tailor care to individuals’ needs.
 
‘It’s promoting the idea that we should be thinking broadly about pain management, and not just be looking at the pain score, but at the functional score as well so we get a better assessment of the patient’s needs,’ she said.
 
Dr Wilson believes the standard will help bring greater consistency in approach to models of care.
‘Some surgeons are really on top of this, while others aren’t,’ she said.
 
‘What we’ve seen is in those hospitals that have really taken this seriously and have got stewardship processes in place, this is already happening. But it is not being implemented in all hospitals.
 
‘It’s about changing what people do routinely.’
 
Dr Wilson said a diverse group of people had collaborated on the clinical care standard, including GPs, patients with lived experience of pain, surgeons, anaesthetists and pharmacists.

‘Everybody involved … has been through this process and come up with what are really sensible guides to support acute hospitals – both private and public – to begin to make these changes and, importantly, link in with us as GPs,’ Dr Wilson said.

‘It will take time, but it’s a really good document.’
 
The RACGPs’ clinical guidelines on drugs of dependence are available on the college website.
 
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