Dr John Thomson is a GP in Berry who works in palliative care at Karinya. He finds managing chronic pain a challenge, as do most GPs who form the front line of chronic pain management. There are now more opioid-associated deaths than road deaths. We have made some progress through codeine upscheduling, with a 50% decrease in prescribing and in overdoses. Luckily we haven’t seen the feared surge in demand for prescribing higher potency opioids since codeine was changed. Unfortunately there are many challenges remaining for GPs in this setting.
- Discuss duration of treatment, side effects and withdrawl issues before starting
- Be prepared to continue prescribing if you start them on opioids
- Start low dose and use for shortest duration
- Use short scripts to begin with – there is no role for authorities for a month supply to begin with
- Be aware of NSW Health legal requirements for prescribing a S8 or benzodiazepine
- This includes patients on Jurnista who will need an authority (even if not drug-dependent) if on it for >2 months.
- Multidisciplinary team care: physiotherapists, rehabilitation specialists, pain specialists, pain psychologists
- Use the Prescription Shopping Information Service (PSIS) 1800 631 181 or PRODA to find information about past scripts
- Check scripts dispensed on MyHealth Record
- Nyxoid is an intranasal preparation of naloxone that is available at pharmacy – talk to your patients about this if there is a risk of overdose
- Opioid-substitution treatments are becoming more available, including methadone, buprenorphine / naloxone
- Smaller pack sizes are coming in 2020
- Managing the inherited pain patient
- Doctor shopping behaviour