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A health board with one of the highest prescribing rates for high-risk pain medicine in Scotland has launched a pharmacist-led initiative to reduce unnecessary prescribing of these drugs for chronic pain.
In a statement published on 27 May 2024, NHS Fife said the ‘Pain Talking’ campaign is aimed at improving patients’ safety by allowing them to take greater control of chronic pain management and promote other non-medical treatment.
High-risk pain medicines include opioids, such as codeine and morphine; gabapentin and pregabalin for nerve pain; anti-inflammatories, such as ibuprofen and naproxen; and benzodiazepines, including diazepam, which is sometimes prescribed to patients experiencing muscle spasms.
These medicines are regularly used in the treatment of chronic pain; however, they are associated with undesirable side effects, including drowsiness, constipation and nausea. Long-term use can also lead to physical dependence, which can lead to overdose.
The campaign will encourage healthcare professionals to discuss the impact of high-risk pain medicines with patients who have chronic pain to improve understanding of their medicines. Clinicians will also be able to signpost patients to an online ‘Pain Talking’ resource hub.
Deborah Steven, clinical pharmacist and programme director for the Pain Talking strategy, told The Pharmaceutical Journal that pharmacists will be central in the campaign’s delivery.
“I really believe the pharmacy profession has got this unique selling opportunity around understanding the challenges patients have with their own medicines,” she said.
“Understanding their [patients] beliefs about medicines, their concerns, and being able to respond … so being able to have a really good conversation with the patients is crucial.
“Whether it be support workers, technicians, pharmacists — wherever they’re at — [they] have an opportunity to improve the delivery of the programme … doing all the training and teaching, to help build people’s confidence [and] support patients with chronic pain,” she added.
NHS Fife’s statement also pointed out that prescribing of high-risk pain medicines has been “consistently above the Scottish average in recent years”.
“Some of these medications which are legitimately prescribed are also known to find their way into the hands of others and sold on for illicit use,” it added.
Public Health Scotland data show that, as of December 2023 — the most recent figures available — NHS Fife had the joint highest prescribing rates, per population, for opioid analgesics of all NHS boards in Scotland.
“What we would anticipate is that there will be a change in prescribing, and that we will see a reduction in prescribing,” Steven added.
“Our overall aim is to be at or below the Scottish average [in prescribing rates] — we don’t want to be that outlier of very high users anymore. But, equally, this is not about prohibition or stopping the use of these medicines at the right time for the right person.
“We have patients out there who benefit well from these medicines, so they should be supported to continue on them, as long as it’s done safely and reviewed regularly to make sure that it’s still safe, ongoing,” she explained.
In 2019, the ‘Painkillers don’t exist’ campaign was launched in the former Sunderland Clinical Commissioning region to tackle opioid addiction, after it was found to have one of the highest prescribing rates of opioids in England.
In an opinion piece published by The Pharmaceutical Journal in July 2023, Rachel Berry, an advanced medicines optimisation pharmacist based in County Durham, said: “[The campaign is] starting to see rates of prescribing reduce, in particular those prescribed longer term opioids.”
