News
GPs critical of ‘intimidating, unpleasant’ warning letter over opioid prescribing
One in five of Australia’s GPs has – or will shortly – received a warning letter over their level of opioid prescribing. Many are not happy.
Almost 5000 Australian GPs will be warned that their rates of prescribing opioids are very high relative to their peers.
GPs who have received the Department of Health (DoH) letter regarding opioid prescribing have hit back over the tactic and called for GPs upset by the process to write to the DoH.
One GP, who wished to remain anonymous, told newsGP the DoH letter was ‘very much the stick and no carrot.’
‘[The letter] was intimidating and unhelpful. I find it odd, because the Department’s role previously has been to inform and guide,’ the doctor said. ‘This is a very strange tactic and it’s overstepping the mark.
‘The stress and the worry: it makes you anxious to think they’re monitoring you over the next 12 months.
‘This is not helpful, not supportive and they’re not listening to doctors. It’s just unpleasant.’
The RACGP made its concerns known in a letter sent to the DoH before the letters were sent out last week.
In the letter, RACGP President Dr Bastian Seidel warned that the wide scope of the letter risked unfairly targeting doctors who had legitimate reasons to prescribe opioids, such as those working in palliative care.
The anonymous doctor echoed those concerns, stating that their rural area has a high proportion of older people, many of whom have legitimate reasons for being prescribed opioids.
‘I do a lot of palliative and aged care,’ the doctor said.
The doctor called on all GPs who receive the letter to contact the DoH to register their concerns.
‘We should be letting them know it was an inappropriate letter and an inappropriate use of data,’ they said.
‘Everyone knows about opioids, and we’re all trying to do the best we can to look after patients.’
The doctor said that alternatives to opioids for chronic pain, such as pain management clinics, often have very long waiting lists.
‘We don’t have a lot of alternatives, and putting the blame on GPs is totally unhelpful,’ they said.
A number of other GPs have commented on a previous newsGP article on the letter, supporting the principle of reducing opioid use but expressing their concern with the approach.
Some GPs said that alternatives to opioids, such as pain management clinics, often had long waiting times. Others who work in palliative care questioned whether the DoH was able to chart the length of time the opioids were being used, and whether the patient was dying.
Another GP said that hospitals and specialists should also be targeted. He said that he often had to try to help patients reduce their high doses of opioids after being discharged from hospitals.
One GP wrote that his main concern was the ‘appalling public access to pain clinics’ and other specialties for uninsured patients suffering chronic pain.
He gave the example of a 77-year-old patient who experienced such great pain from her osteoarthritis that she considered suicide. His patient was looking at an eight-month wait for a hip operation, and a 12–18 month wait for a pain clinic. He wrote that the only solution was careful use of opiates until the operation.
The doctor asked whether the DoH’s data might be ‘skewed to pick up GPs who work in [bulk billing or] mixed billing practice where access to services is appalling so the amelioration of pain falls, rightly, to the GP’.
‘I have no problem with tackling the problem of over prescription of [antibiotics], but opioid analgesia is a completely different issue and cannot be viewed in the same way with such a generalised sweep,’ he wrote.
Another GP observed that fewer long-term opioids is undoubtedly a good aim.
‘Unfortunately, the reality is that no one has provided a satisfactory alternative management regime for those trying to manage the tsunami of chronic pain that GPs face every day,’ he wrote.
A DoH spokeswoman told newsGP that the campaign came from concerns that Australia is trending down the same path as other countries facing opioid crises.
She said that while no further action would be taken for the large majority of GPs who received the letter, a small number of GPs whose prescribing of opioids was very high relative to their peers may be asked for an interview under the DoH’s Practitioner Review Program to understand the reasons for the pattern of prescribing.
‘The Chief Medical Officer, Professor Brendan Murphy, has written to GPs who prescribe more opioids than others – the top 20% – to raise awareness and encourage self-reflection about prescribing practise,’ she said.
‘The intent of the letters is to raise awareness and have GPs reflect on their prescribing behaviour and to see if there are any opportunities in their practice to reduce prescribing where clinically indicated.
‘After self-reflection, a GP may determine that they are prescribing in an appropriate manner for their patient group.
‘The Department looked closely at the Pharmaceutical Benefits Scheme [PBS] data and excluded PBS items that were identified as palliative care. Codeine was also excluded given recent changes in scheduling.’
The DoH spokeswoman said that the department would continue to monitor prescribing practice.
The DoH website for the campaign notes that pharmaceutical opioid deaths now significantly exceed heroin deaths.
department of health opioid prescription prescribing
newsGP weekly poll
How often do you feel pressure from patients to prescribe antibiotics that are not clinically necessary?