Doncaster CCG Position Statement on Opioid Prescribing 2021
Developed in collaboration with the Emergency/ Urgent Care team and Pain Management team from Doncaster and Bassetlaw NHS Teaching Hospital Foundation Trust (DBTHFT)
In GP Practice and Primary Care
This position statement is intended for use in line with your own clinical judgement
The WHO pain ladder does not apply to the management of chronic pain and there is little evidence to suggest opioids are helpful in long term pain1 (lasting over 3 months).
In a recent report, Public Health England found that prescribing opioid pain medicines for longer than 3 months is associated with opioid overdose and dependence2
Doncaster has been found among the highest for rates of opioid prescriptions within England and Wales2
If you suspect drug-seeking behaviour from your patient in any setting, Doncaster CCG fully supports and encourages any decision to refuse to prescribe opioids.
The Faculty of Pain Medicine (Royal College of Anaesthetists), in partnership with Public Health England advises that if a patient has pain that remains severe despite opioid treatment, it is not working and should be stopped, even if no other treatment is available3.
Tapering or stopping high dose opioids requires careful planning and collaboration with the patient and all members of their healthcare team2.
For advice on stopping opioids safely, refer to the following: Tapering & Stopping of opioids. Faculty of Pain Medicine, RCoA©2019
https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-aware/structured-approach-to-prescribing/tapering-and-stopping
All drugs prescribed for pain should undergo regular review to evaluate continued efficacy. Periodic dose tapering is necessary to evaluate on-going need.
Prescribers should be mindful of the risk of diversion of opioids and other dependence forming medication and should consider the safeguarding implications of prescribing.
Alternative treatments
Gabapentin and pregabalin should only be prescribed for their licensed indications.
DBTHFT and Doncaster CCG do not support the use of pregabalin and gabapentin to treat chronic, nociceptive (non-neuropathic) pain in adults.
Patients can use various self-management techniques to help with their pain.
The NHS: 10 Ways to reduce pain https://www.nhs.uk/live-well/healthy-body/10-ways-to-ease-pain/ provides further advice, including meditation or gentle exercise such as walking, swimming, gardening and dancing.
In Urgent and Emergency care
Colleagues working in Urgent Care and Emergency Care departments at the Doncaster and Bassetlaw Teaching Hospital NHS Foundation Trust are supportive of this position statement in primary care.
Patients will not receive a supply or prescription for opioids to manage their chronic pain in these settings.
For patients requiring analgesia to treat an acute condition, a limited amount of pain medication will be supplied for the short-term basis.
The amount issued will be communicated to the GP who can then review ongoing pain management needs if appropriate.
Further information and useful resources:
Doncaster CCG Medicines management team donccg.medicinesmanagementadmin@nhs.net
http://medicinesmanagement.doncasterccg.nhs.uk/controlled-drugs/opioid-deprescribing-and-review-resources/
https://www.rcgp.org.uk/clinical-and-research/resources/a-to-z-clinical-resources/dependence-forming-medications.aspx
- Royal College of Anaesthetists (The), Faculty of Pain Medicine. The Effectiveness of Opioids for Long Term Pain. 2019
- Public Health England. Dependence and withdrawal associated with some prescribed medicine: An evidence review. 2019
- Royal College of Anaesthetists (The), Faculty of Pain Medicine. Opioids Aware: A resource for patients and healthcare professionals to support prescribing of opioid medicines for pain. 2016
- NHS Sunderland CCG. https://www.sunderlandccg.nhs.uk/wp-content/uploads/2019/09/FINAL-SCCG-Position-Statement-on-Opioid-Prescribing-V5.pdf
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Self-Care Statement 2021 for Patients
Doncaster CCG and its members do not support the prescription of vitamin and minerals, medicines and treatments for minor or self-limiting conditions, where:
- Self-care is the most appropriate route
- Medicines and treatments are available to buy over the counter
Our NHS spends around £569 million a year on prescriptions for medicines for minor conditions. Minor conditions are exactly that, they are not serious and usually disappear in a few days without any treatment.
If we can reduce the amount we spend on these prescriptions, we can give priority to treatments for people with more serious conditions, such as cancer, diabetes and mental health problems.
Therefore, prescription medications for minor and self-limiting conditions such as colds, hay fever and head lice are now no longer ordinarily available from Doncaster practices and appointments should not be requested for these conditions. This is in line with national NHS England guidance, which is supported by professional and public bodies.
Local practice and pharmacy staff can provide a list of these minor and self-limiting conditions and treatments. If you feel you need them, they are available to buy ‘over the counter’ at your pharmacy or supermarket, and often at a relatively low cost. There is also a minor ailment scheme at participating pharmacies. Where an ailment is considered not to be a minor self-limiting condition, prescriptions will remain available as a treatment route. You can seek advice from your pharmacist or other healthcare professionals.
For further information, contact Doncaster Clinical Commissioning Group donccg.enquiries@nhs.net or visit the following NHS England webpage:
https://www.england.nhs.uk/medicines/conditions-for-which-over-the-counter-items-should-not-routinely-be-prescribed/.
Further information is also available from regional 569 million reasons campaign: http://569millionreasons.co.uk/