Responsible opioid prescribing
Dr Helen Fulcher, Goodfellow GP Advisor talks with Northland General Practitioner and Addiction Medicine Specialist Dr Alistair Dunn about opioids in the context of pain management in the non-palliative setting.
Topics covered include:
- Reframing pain management from curative to functional for chronic pain.
- Prescribing opiates - limited indications for prescribing, checking for red flags and tips for safe prescribing.
- Opioid substitution treatment – goals of treatment, available medication, increasing awareness of co morbid conditions in primary care.
Resources
- Unintentional misuse of prescription medicines bpacnz (2018)
- Reviewing patients using opioid medicines long-term for non-cancer pain bpacnz (2018)
- Helping patients cope with chronic non-malignant pain: it’s not about opioids bpacnz (2014)
- Opioids HQSCNZ (updated 2019)
- Opioid painkillers Health Navigator NZ
- OST and you Matua Raki (2014)
Peer group discussion points |
Patients with prominent pain issues are often in significant distress and may have an expectation that pain may be ‘cured’ or ‘fixed’ by their treating physician.
Opioid prescribing may be required for acute pain and short-term prescribing. Alastair discusses his methods for prescribing when required. These may include tight dispensing arrangements e.g. weekly, clarifying a maximum dose, efficacy, on going indication and being ready to stop the medication if no benefit is found.
Assessment of new patients potentially requiring opioid treatment, or reviewing current patients using opioids in part involves identifying risk, red flags and review of ongoing indication.
Opioid Substitution Treatment (OST) provides a regular daily dose of opioids to keep an individual stable and avoid withdrawals. The goal is stability and reducing relapse into illegal drug use.
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