OPIOID RISK MANAGEMENT IN LONG TERM CONDITIONS

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The opioid epidemic isn’t just in the USA. it’s here in Scotland and adjoining countries. 

As a sufferer of many long term conditions including fibromyalgia of which I’m founder and managing director of FFU Scotland a social enterprise nonprofit, I have daily pain. 

There are multimodal strategies to address the pain and symptoms however the first step with a gp ,even sometimes before full diagnosis is through prescribed medications. This scarily includes opioids for many. 

There is clear research around the impact opioids have and within fibromyalgia they are readily given despite the evidence of it not addressing nerve pain and infact increasing pain with long term use, known as opioid hyperalgesia. 

Opiods are prescribed with no formal recorded risk assessment to ascertain any likelihood of addiction or suicidal ideation and at present very poorly reviewed with patients being given repeat prescriptions for multiple years with very little input to try alternatives and taper the patient down or off. 

What I am calling for here is for the head of nhs Scotland , first minister of Scotland , the health msp and the directors of gps in Scotland to not only respond to opioid issues and long term pain management but to place early intervention at the forefront of any pain management pathway. 

Many with long term conditions like fibromyalgia have significant mental health issues yet this isn’t recognised or assessed as a risk when prescribing to certain patients. 

What is required is a formal recorded basic risk assessment tool before any prescribing by all general practitioners or anyone prescribing in pain management and have regular reviews even through trained nurses who can adequately and legitimately change any dosage. Also within this to explore alternative strategies to pain. We know there are pain management teams and physiotherapist within, however most areas in Scotland sadly do not meet the 18 week waiting times advised by government and is more likely from our consultation with members to be 30-52 weeks. Thus within this other alternatives are required. 

The opioid risk assessment tool I am calling for to be considered would not only have an impact on the safety of the patient and the care management put in place, it would eventually have some impact on the numbers presenting or being referred by gps to addiction teams due to changed behaviour, increase and addition of over the counter meds due to tolerance issues to meet the physical craving and need and so forth. Technically passing over to health and social care teams something created by poor risk management at early stages of prescribing to someone with a long term condition. 

The tool on its own is only one part. The full pathway for pain requires to be reassessed of which I believe is happening ,however I believe a risk assessment tool would be advantageous to begin the journey with the patient safely before any prescribing of opioids. 



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