Opioids & pain 2
Track 25
| Friday, October 27, 2023 |
| 10:35 AM - 12:30 PM |
| Meeting Room E3.7 |
Speaker
A/Prof Carmel Martin
Associate Professor (adjunct)
Monash University
Unintended Consequences – case studies of (de)prescribing opioids for chronic pain. Implications for practice and policy
10:35 AM - 11:30 AMSummary
Background
Increasingly, opioid (de)prescribing for chronic pain is the subject of actions by governments, academic teachers, and institutions.
Methods
Autoethnography which I, as a GP, connect my personal experiences of (de)prescribing opioids for chronic pain to wider practice and policy.
Findings
Case 1. Mary aged 37, on long-term opioids for chronic pain and PTSD, contemplated their reduction as she re-entered the job market. Her long-term partner suddenly became violent. Extremely traumatised, Mary accessed an out-of-town domestic violence (DV) shelter. A local practice immediately (de)prescribed smaller lower doses of the opioids by different GPs “they were not opioid prescribers”. She called me in a suicidal crisis with panic about her pain and dependence. Via telephone consults, I reinstated her regular medications and DV services helped her slowly stabilise.
Case 2 Belinda 55 years is on long-term opioids for complex regional pain syndrome. She fell and fractured her nose and toe with extensive tissue damage. She was was denied additional pain medication because she was an opioid 'user' in the emergency department: "they were not opioid prescribers".
Case 3. Suzie aged 58, sought my help to reduce her long-term prescribed opioids and benzodiazepines for chronic pain, as she had been told by the GP nearest her home, that she was an addict and drug-seeking. He/she was not an opioid prescriber, and would not "prescribe" for her. Over 12 months we have halved her medications, but it is an ongoing struggle.
Discussion
Deprescribing is failing to reduce opioid deaths in the US. Dose tapering has been significantly associated with overdose or mental health crises. Current strategies of harm reduction may overlook stages of change including pre-contemplation, contemplation, preparation, action, maintenance and relapse. People, prescribed opioids for chronic pain, may be rejected and stigmatised in general practice and emergency departments and denied appropriate care.
Increasingly, opioid (de)prescribing for chronic pain is the subject of actions by governments, academic teachers, and institutions.
Methods
Autoethnography which I, as a GP, connect my personal experiences of (de)prescribing opioids for chronic pain to wider practice and policy.
Findings
Case 1. Mary aged 37, on long-term opioids for chronic pain and PTSD, contemplated their reduction as she re-entered the job market. Her long-term partner suddenly became violent. Extremely traumatised, Mary accessed an out-of-town domestic violence (DV) shelter. A local practice immediately (de)prescribed smaller lower doses of the opioids by different GPs “they were not opioid prescribers”. She called me in a suicidal crisis with panic about her pain and dependence. Via telephone consults, I reinstated her regular medications and DV services helped her slowly stabilise.
Case 2 Belinda 55 years is on long-term opioids for complex regional pain syndrome. She fell and fractured her nose and toe with extensive tissue damage. She was was denied additional pain medication because she was an opioid 'user' in the emergency department: "they were not opioid prescribers".
Case 3. Suzie aged 58, sought my help to reduce her long-term prescribed opioids and benzodiazepines for chronic pain, as she had been told by the GP nearest her home, that she was an addict and drug-seeking. He/she was not an opioid prescriber, and would not "prescribe" for her. Over 12 months we have halved her medications, but it is an ongoing struggle.
Discussion
Deprescribing is failing to reduce opioid deaths in the US. Dose tapering has been significantly associated with overdose or mental health crises. Current strategies of harm reduction may overlook stages of change including pre-contemplation, contemplation, preparation, action, maintenance and relapse. People, prescribed opioids for chronic pain, may be rejected and stigmatised in general practice and emergency departments and denied appropriate care.
Takeaways
1. Recognise stages of change in people on long-term prescribed opioids for chronic pain.
2. Contextualise the nature of an individual's physical and emotional pain before beginning to deprescribe.
3. Be mindful of stigmatising the individual in the process of addressing the potential harms of particular drugs.
2. Contextualise the nature of an individual's physical and emotional pain before beginning to deprescribe.
3. Be mindful of stigmatising the individual in the process of addressing the potential harms of particular drugs.
Biography
Carmel Mary Martin General Practitioner in Brisbane and Researcher in Victoria, Monash University.
Worked in Australia, the UK, Canada, Ireland, US and returned to Australia in 2016. Her current project is primary health care systems and complex adaptive chronic care. Clinical and research interests revolve around the care of individuals with unstable health journeys. Chair of WONCA Special Interest Group and Co-Chair of NAPCRG Working Group on Complexities in Health.
