GPs need better training in opioid tapering
Author: Jo Carlowe
GPs need better guidelines and training to tackle chronic opioid use in patients.
This is the message from researchers at the University of East Anglia, who today launched a new toolkit designed to help GPs develop an approach to opioid tapering.
The Medicines Optimisation Group East Anglia combined research evidence with experiences of health organisations and practitioners to develop a programme theory that identified seven key features that the researchers say should be included in all opioid prescribing interventions.
The seven areas of best practice to tackle chronic opioid use in non-cancer pain, includes the suggestion of associated incentivisation for prescribers to identify, review and discuss tapering with patients prescribed long-term opioid therapy.
The recommendations come after figures for England and Wales reveal an increase in opioid prescriptions of more than 60% over the last decade - from 14 million in 2008 to 23 million last year.
Lead researcher Dr Debi Bhattacharya, from UEA's School of Pharmacy, said: "Opioids, like morphine, tramadol and fentanyl, can be effective for the short-term management of severe pain. However, they are highly addictive which makes stopping difficult yet long-term use can impair quality of life and overuse can be deadly.
"GPs and other health professionals need to urgently, proactively work with patients prescribed long-term opioids for non-cancer pain to gradually reduce or 'taper' their doses. But if GPs are expected to initiate discussions about tapering or stopping opioids, they must be equipped with training to manage the psychological challenges experienced by patients when trying to reduce their opioid use. Without this training, prescribers are reticent to open 'a can of worms' that they know they don't have the skills to manage.”
Dr Bhattacharya added: "For opioid tapering interventions to be effective, GPs need training in giving their patients the skills to manage any withdrawal effects.
“There needs to be a clear expectation that opioid de-prescribing is the responsibility of the prescriber. Incentives may help GPs and other health professionals to prioritise reducing the amount of opioids being prescribed to patients, particularly among those who have been taking them long term.
"Prescribers need to better understand the consequences of excess opioid use, and they need better guidelines about how to gradually reduce or 'taper' doses.”