Listen, assess, encourage, support: Requests for drugs of dependence

Morgan Liotta

19/02/2020 1:17:18 PM

The RACGP has released a new guide designed to help GPs identify and respond to requests that might be inappropriate.

Drugs of depenence
Responding to requests requires a tailored approach for each patient

‘GPs are likely to be exposed to increased requests for prescriptions.’
That is a key line from the RACGP’s new Drugs of dependence: Responding to requests fact sheet.
Requests for drugs of dependence associated with the most problematic use include opioids, benzodiazepines and steroids.
‘Responding to requests for medications that can be high-risk. It requires patience, skill and compassionate curiosity,’ Dr Hester Wilson, Chair of the RACGP Specific Interests Addiction Medicine network, told newsGP
‘Luckily these are core skills to good GPs.’
Once behaviours suggesting problematic or risky use of drugs of dependence are identified, the RACGP recommends key steps for management:

  • Listen with an open mind
  • Conduct a thorough assessment
  • Encourage action
  • Offer support
  • Develop an ongoing plan
Taking the necessary time with each patient and considering them as an individual is vital.
‘Every person we see has a journey that has led them to the point when we see them,’ Dr Wilson, who is also facilitator of the RACGP Alcohol and other drugs GP education program, said.
‘While it may seem easier to simply give a patient what they request or to give a blanket “no”, both of these options potentially result in harm. 
‘I suggest instead walking a road that puts understanding the unique experience of each person we see at the centre of our consultation, while at the same ensuring we do what is safe and in the best interests of the person, even if it is not what they are asking for.
‘This can mean saying, “I am sorry I can’t prescribe this medication the way you’re requesting as we now know that this can be unsafe and may cause you harm. I understand that you have been prescribed this before and are understandably worried about any change, I want to assist you to be well”.’
Practice-wide approaches to identifying and safely managing requests for drugs of dependence requests include checking a patient’s prescription history.
However, the RACGP notes the importance of acknowledging there is no ‘single profile’ for people who develop problematic or risky use, and responding to requests requires a tailored approach for each patient.
‘The lived experience of patients prescribed these medicines is often complex and should be acknowledged,’ the fact sheet states. Harm-minimisation strategies can be applied with appropriate assessment of each individual patient.
‘I don’t suggest [GPs use] blanket rules or posters saying you don’t prescribe drugs of dependence,’ Dr Wilson said. ‘Instead, [I suggest] a more nuanced approach, one that allows compassion and safety at the same time.
‘Everyone we see has compelling reasons for their request. Our role is not to judge the patient’s current experience based on our own values of such behaviour, but to understand the lived experience of the person we’re seeing at the same time as conducting an ongoing assessment of what is safe, based on a comprehensive history and therapeutic alliance with the person.
‘Even if they are disappointed and cannot agree with your plan, they will have had a respectful experience that sought to understand them and do what was safe, and this will help them to seek help in the future.’
In addition to the newly released fact sheet, the RACGP’s Prescribing drugs of dependence in general practice, Parts A, B and C are designed to guide general practice teams through provision of care and safe prescribing to patients experiencing problematic use of drugs of dependence.
The Alcohol and other drugs GP education program provides tailored education for GPs to address and support alcohol and other drug use across various communities. The first Treatment Skills Training workshop takes place on 14 March 2020.
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