Prescribing drugs of dependence in general practice

Part C1 - Opioids

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Last revised: 15 Apr 2020

Foreword

This guide has been produced largely in response to increasing community and clinical concerns about the use and safety of opioids. This isn’t a new problem. We’ve been exploiting the analgesic (and other) properties of the opium poppy since prehistoric times. Perhaps the peak of use was during the Great Binge (~1870–1914) when opium and its derivatives were hailed as medical miracles and used by young and old. Mothers gave opium to their ‘fussy’ infants and Bayer made heroin for headaches, coughs, period pains and even as a cure for morphine addiction.

Today, opioids are ‘controlled’ through both medical and legal systems. Despite this, opioid use has been fuelled by drug company marketing, inappropriate therapeutic ideals, and a broad public demand for analgesia for chronic pain. The use of opioids has increased to a point where inappropriate prescribing and harm has ensued.

Clinical governance has never been more important. General practitioners (GPs) must prescribe these drugs judiciously in order to protect patients from harm. This means acting in accordance with national and state regulations, accountable prescribing, and particularly with opioids, understanding pain and pain management.

GPs should also be aware of the broad issues around opioid use in society, as well as specific problems at a patient level and how to address these issues with evidence-based interventions.

This guide, and its companion, Part C2: The role of opioids in pain management, is a synthesis of the clinical standards and best available evidence for opioid use in the primary care setting.

In completing this guide, The Royal Australian College of General Practitioners (RACGP) acknowledges the work of the key advisers and reviewers, and the many people who have provided constructive feedback.

The RACGP welcomes feedback on this guide to continually improve services at the general practice level. Please use the feedback section on our website to help co-create this guide.

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