By limiting repeat prescriptions for patients, the NHS — and in particular general practice — is protecting the UK from an opioid crisis similar to the one in the United States, the Royal College of General Practitioners (RCGP) has said.
But pharmacy leaders have warned of the effects that NHS England guidance on prescribing low value and over-the-counter (OTC) medicines could have on opioid prescribing.
The RCGP was responding to an investigation, carried out by The Sunday Times, which found that the number of opioids prescribed by UK GPs had risen by 10 million in a decade. According to NHS data, doctors prescribed 41.4 million opioids in 2017; the equivalent of 79 pill packs per minute.
“Most patients don’t want to take medication long term — and GPs don’t want to prescribe it long term,” said Helen Stokes-Lampard, chair of the RCGP.
“It’s frustrating for all involved that there is a lack of alternative treatments available — and for those that are, for example some psychological therapies that have been found to have benefit for patients with chronic pain, access is patchy across the country.”
Stokes-Lampard added that more high-quality research into pain is needed, as well as more clinical guidelines for GPs and other healthcare professionals.
“NICE have produced guidance on lower back pain and neuropathic pain, but guidelines on general pain won’t be ready until 2020,” she added.
Sandra Gidley, chair of the Royal Pharmaceutical Society English Pharmacy Board, warned of the possible consequences that NHS England restrictions on prescribing of low value and OTC medicines could have on opioid prescribing.
“We also have to acknowledge the potential unintended consequences of the low value medicines scheme,” she said. “If paracetamol is removed from prescription then some prescribers may go down the path of prescribing more opiate-based analgesics.
“There is a strong case for adding opioids to the new medicines service, which would provide another level of advice and counselling for patients,” she added.
In January 2018, Public Health England was commissioned by the UK government to review dependence on prescription drugs, including opioids. Its review is due to be published later in 2019.
An expert working group of the UK’s Commission on Human Medicines, a committee within the Medicines and Healthcare products Regulatory Agency, also launched a review at the beginning of February 2019 with the aim of examining the risks and benefits of opioid medicines.
Research published in
JAMA Network Open on 22 February 2019 found that opioid-related deaths across the United States have increased fourfold in the past 20 years.