Telling GPs to ‘think twice’ about prescribing opioids may prevent tens of thousands of patients from becoming addicted to them, research suggests.
Experts have been warning for years that Britain is on track for an American-style opioid crisis, with the number of strong painkillers distributed doubling in the past two decades.
Officials have tried to spotlight the prescription of the drugs — such as codeine and tramadol — over concerns about addition and dependence.
But a simple messaging campaign tailored specifically to GPs could help tackle the problem, University of Leeds academics say.
It was tested in West Yorkshire and resulted in 15,000 fewer patients being prescribed opioids over the course of a year. And the campaign saved the NHS £700,000, calculations suggested.
If rolled out nationally, experts estimate it could lead to 406,000 fewer people being prescribed the powerful drugs. And it would save the health service about £18.5 million.
The ‘feedback’ intervention provided GPs with an update every other month on the number of people in their practice who were prescribed opioids.
GPs participating in the study were reminded of the need to exercise caution when starting opioids.
And they were sent “persuasive messages” asking if they should take people off the drugs if they didn’t offer any benefit.
From 1998 to 2018, the number of opioid prescriptions dispensed by general practitioners in England more than doubled. The NHS now spends more than £260 million a year on the medicines.
Meanwhile, rates in America have fallen only slightly over the past decade “despite increased awareness of the risks and abuse of opioids,” researchers said.
Opioids – such as morphine, fentanyl and codeine – are morphine-based drugs that can lead to addiction, dependence and overdose. From 1998 to 2018, the number of opioid prescriptions issued by GPs in England more than doubled, raising concerns that the UK is in an ‘opioid epidemic’
The graph shows the average number of adults prescribed opioids per 1,000 adults from 2013 to 2018. The gray line represents those GPs who did not participate in the ‘think twice’ campaign, while the black line represents those who did. were in West, shows. yorkshire. These practices received updates on their opioid prescribing rates every two months. The graph shows that opioid use increased from 2013 to 2016. But when the campaign started in 2016, the rates dropped among participating practices, while continuing to rise among non-participating surgeries. And after the year-long study, rates in West Yorkshire practices continued to fall, but at a slower pace
Opioids are often given as painkillers, but the Royal College of Anesthetists warns that there is “little evidence” that they help with long-term chronic pain.
And guidelines from the National Institute for Health and Care Excellence (NICE), which provides information to healthcare professionals, states that patients with long-term pain should not be started on opioids.
Researchers said the doctor’s prescribing patterns are what drives the walk, rather than the patient’s needs.
HOW AMERICA BECAME ADDICTED TO OPIOIDS
Prescription opioids and illegal drugs have become incredibly ubiquitous in the US, and things are only getting worse.
In the early 2000s, the FDA and CDC began to notice a steady increase in cases of opioid addiction and overdose. In 2013, they issued guidelines to curb addiction.
However, that same year — now considered the year the epidemic spread — a CDC report revealed an unprecedented rise in opioid addiction rates.
Overdose deaths are now the leading cause of death among young Americans — more deaths in a year than ever were killed annually from HIV, gun violence or car accidents.
In 2019, the CDC revealed that nearly 71,000 Americans died of drug overdose.
This is an increase from about 59,000 just three years earlier, in 2016, and more than double the death rate from ten years ago.
It means that drug overdoses are currently the leading cause of death for Americans under the age of 50.
The data exposes the bleak state of the US opioid addiction crisis, fueled by deadly manufactured drugs like fentanyl.
They said patients have a “strong expectation” that GPs can provide pain relief, which increases the pressure to prescribe them.
There are also “big differences” in opioid prescribing between different practices, suggesting it is driven by clinicians’ habits.
The longer people take the drugs, the more their bodies learn to tolerate them and the higher the doses they need to get the right effect.
It also becomes increasingly difficult to quit and once the body becomes addicted, stopping it suddenly can have deadly consequences.
Researchers piloted the campaign to reduce opioid prescribing in 2016 at 316 GP practices in the West Yorkshire region, serving 2.2 million people. The doctors compared the practice with 130 unnamed GP practices.
In the months leading up to the study, the number of patients prescribed opioids in surgeries in West Yorkshire was 58.1 per 1,000 adult patients and increased by 0.18 per 1,000 per month.
And the rate was 62.2 per 1,000 patients in the other group and increased by 0.36 per 1,000 patients each month.
Patients with cancer – who use the drugs to relieve pain – or drug addiction are not included in the figures.
The study, published in PLOS Medicine, found after the trial was conducted, rates in West Yorkshire fell.
Each month, about 0.11 patients per 1,000 received less opioids, they calculated. Experts claimed the decline was “modest” but stressed it was “substantial” at the population level.
Meanwhile, the prescribing rate among the non-participating practices increased by 0.54 per 1,000 patients.
dr. Sarah Alderson, a GP in Holmfirth, West Yorkshire, who led the study, said: ‘Our analysis shows that the intervention was particularly effective in getting GPs to stop or reduce their prescribing for those high-risk groups such as older patients or those who also had mental illness.
‘The research shows that GPs can be very effective in identifying other ways to support patients with chronic pain.
“The feedback intervention can be easily adapted and delivered elsewhere at a relatively low cost.”
But the experts noted that declining opioid prescription rates at participating practices began to slow once they stopped receiving updates from the researchers.
So dr. Alderson said the campaign needs to be sustained over a longer period of time.
dr. Tracey Farragher, an epidemiologist at the University of Manchester and an analyst on the study, said: “This study is a great example of how medical records can improve patient care by providing doctors with up-to-date information on how much of their patients are being prescribed opioids. .’