UK GPs are underequipped to handle growing chronic opioid use, report warns

New research from the University of East Anglia (UEA) has argued that general practitioners (GPs) in the UK are lacking the skills needed to adequately handle chronic opioid use in their patients, and the psychological challenges which come with the goal of managing and reducing their use of the addictive and often harmful drugs.

The release of the report follows significant findings which show that the number of opioid prescriptions in England and Wales had rocketed by 60% over a ten-year period, rising from 14 million in 2008 to reach 23 million in 2018. The figures have risen broadly in line with trends seen around the world under the umbrella of the opioid crisis, which has manifested most profoundly in the US.

The team, led by Lead researcher Dr Debi Bhattacharya, from UEA's School of Pharmacy, said that they had carried out "a realist review which offers a structured approach to capturing the details of these local and national activities in order that we may learn from the existing research literature and the practice environment."

The UEA’s report was made available alongside a toolkit, developed by the Medicines Optimisation Group East Anglia with support from the National Institute for Health Research’s (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) Eastern, which is based on an opioid tapering programme which includes "seven key features that should be included in all opioid deprescribing interventions".

"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," explained Dr Bhattacharya. "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," she continued. "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."

Matt Fellows

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