Opiate and Controlled Drugs Policy
At Pioneer Medical Group, our priority is to provide safe, evidence based and compassionate care. We follow National Guidance regarding the use of controlled drugs
What are controlled drugs?
Controlled drugs or CDs are medications that are closely regulated by the government because they carry a high risk of addiction, abuse and potential harm
These include:
- Opioid painkillers: morphine, oxycodone, fentanyl, tramadol
- Gapapentinoids; pregabalin and gabapentin
- Benzodiazepines and Z drugs; diazepam, temazepam, lorazepam, zopiclone, zolpidem
Our approach:
- We are careful about starting controlled drugs and will only do this for conditions where National evidence advises it is safe to do so
- We aim to improve patient safety and overall health by slowly reducing controlled drugs where possible
Lost or stolen medications:
- Replacement prescriptions for lost, stolen or spilled controlled drugs will generally not be reissued
- This policy is in place to reduce the risk of misuse, diversion and accidental overdose
- If medication is reported as lost or stolen, we will fill in a 'lost prescription contract’ with you. We will ask you for a police crime reference number if your prescription is stolen
- We may need to move you to weekly or even daily prescriptions to improve safety
Opiates
Opiates are a group of painkilling medication that includes codeine, tramadol, dihydrocodeine and morphine. Sometimes an opiate is combined with paracetamol, e.g. co-codamol is codeine and paracetamol together in one tablet.
Notice
These medications used to be commonly prescribed for long-term or chronic pain. But we now know that they can cause more harm than good and there has been a change in approach to how these medications are used.
What are the risks of long-term opiates?
There is a long list of risks, but these are a few of the most important:
- Side effects, e.g. constipation, nausea, drowsiness
- Dementia – multiple large studies show a link between long term opiate use and increased a significant increased risk of dementia
- Falls
- Potentially life threatening side effects such as breathing suppression, heart problems and a higher overall risk of death
- Worsening of pain (nerve endings are ‘sensitised’ to pain)
- Immune function reduced (higher risk of infections)
- Libido reduced (men and women)
- Addiction
When should opiates be used?
Do
- For short term pain (e.g. after a broken bone or an operation)
- Poorly controlled cancer pain
Don't
- For chronic (long-term) non cancer pain, e.g. lower back pain, arthritis, fibromyalgia etc*
*There can be a role for opiates here, e.g. when used short term for a flare of pain. The aim should be to take the lowest dose for the shortest time and then stop
What can be done to help chronic non-cancer pain?
LOTS! Non opiate painkillers have a role, support with pain from our social prescribing team, physiotherapy, weight management, talking therapies, Pioneer’s ‘meet in the park’ group, hospital pain clinic etc
What is Pioneer’s policy regarding prescribing of opiates?
- We work as a team to try and keep our prescribing as safe as possible. We follow National guidance that opiates should not be routinely prescribed for chronic non cancer pain. We will aim to slowly wean patients with chronic pain who are prescribed long-term opiates off these medications and will support each patient through this
- If you are discharged from hospital on a new opiate medication, this will not be put onto repeat prescription. You will be sent a text message asking you to book an appointment to review your pain if you need to
What if you are already taking Opiates?
- If you join our practice and already take these medications for non-cancer pain, we will work with you to review and gradually reduce (wean) your dose
- This process will be done safely and supportively; we will offer guidance (as above) about other things that can help chronic pain
If you choose not to reduce harmful medications or do not engage in safety work regarding medications
- We understand that changes to longstanding medications can be frightening or difficult
- We will work with you to try and support you
- Our clinical team, care coordinators and social prescribing team will offer support
- We will make decisions with you, giving you some control and trying to go at your pace
- If you do not want to work with us or engage in making medications safer, you should not register with Pioneer Medical Group
Please watch - Opiate videos:
Brainmain stops his opioids
Meet in the Park, Pioneer
Sean’s Story
Gabapentinoids
- Gabapentinoids are a class of medication that includes gabapentin and pregabalin. They are controlled drugs (see above).
- Knowledge about pain medications is always changing and we now recognise gabapentin and pregabalin as 'high-risk' medications that can cause serious / life threatening side effects. This is more common in people over the age of 65y and in those also taking opiate medication (codeine / tramadol /morphine).
- Pioneer has recently changed its policy and will only prescribe gabapentinoids for licenced indications; Epilepsy, neuropathic (nerve pain) and sometimes generalised anxiety disorder
- If you are prescribed a gabapentinoid for an indication that is not licenced, we will aim to slowly withdraw and stop your medication (with support).
- Gabapentinoids are NO LONGER prescribed for fibromyalgia, there is no evidence that they work and the risks are too high
- Gabapentinoids that are started in hospital will not automatically be put on repeat prescription, you will be asked to discuss whether they are working with your GP or one of our pharmacists