Patients to get early checks on painkiller use to cut addiction

PATIENTS prescribed opioid painkillers should be reviewed by their GP to reduce the risk of addiction and overdose, new NHS guidelines say. The recommendation comes amid soaring numbers of opioid prescriptions being handed out by doctors.

These include morphine, tramadol, oxycodone and codeine, which can all treat acute or chronic pain but patients can become dependent on them if taken regularly.

Official NHS figures show a total of 2.7million prescriptions for such drugs were handed out in Scotland last year, compared to 1.6million a decade earlier.

A review of official guidelines for chronic pain patients has now been published by the Scottish Intercollegiate Guidelines Network, which makes recommendations to NHS professionals.

They spell out new measures to help prevent patients with chronic pain becoming addicted to opioids or overdosing.

Opioids are prescribed to treat severe symptoms such as back or neck pain after an injury as well as arthritis. They are also given to patients before and after operations and many end up taking the strong painkillers for longer than they should.

Chronic post-surgical pain is a growing problem as the population ages and more operations are carried out.

In 2004/5 there were 1.3million opioid painkiller prescriptions dispensed in Scotland, a figure that rose to 1.6million in 2006/7 and 2.7million in 2018/19. The cost of prescribing the drugs soared from just under £18million in 2004/05 to around £29million last year.

Patients are diagnosed with chronic pain if their pain does not go away after 12 weeks, affecting one in five Scots.

The guidelines state patients prescribed opioids should

‘Protected from harmful effects’

receive early reviews of any newly prescribed medication, and ongoing reviews.

Although still recommended for short to medium-term treatment, long-term use of opioids can put patients at risk of dependence and make the drugs less effective at blocking pain. Professor Lesley A Colvin, co-chair of the Guideline Development Group and Professor of Pain Medicine at the University of Dundee, said: ‘Opioids are powerful medicines.

‘The purpose behind this review is to ensure those who benefit from opioids for chronic pain continue to get the relief they need, but are also protected from harmful effects.

‘The new evidence around potential harms and benefits has resulted in a change in our recommendations about how best to use opioids.

‘Opioids should only be started after careful assessment, with agreement that benefits must outweigh risks.

‘The best evidence tells us that better management of opioid prescribing, alongside consideration of other management strategies – such as supporting increased physical activity – with increased reviewing of patients, will give patients the protection they need.’

Patients can also develop opioid-induced hyperalgesia, an increased sensitivity to pain.

Dr Safia Qureshi, director of evidence for Healthcare Improvement Scotland, said: ‘It’s important that those who need strong pain relief get the medication they need, but are kept safe from the dangerous side effects associated with these powerful medicines.

‘We would urge healthcare professionals to make use of the updated guideline to ensure that people get the best possible care.’