Prescribing drugs of dependence in general practice, Part A

1. Introduction
1.2 How to use this guide
☰ Table of contents

This guide is designed to assist GPs in the management of drugs of dependence. It is not a set of mandatory rules. General practice has varying degrees of exposure to issues surrounding drugs of addiction. Each practice needs to determine which features of this guide are relevant for their circumstances.

General practices need to consider the recommendations and implement these according to their local circumstances.

The appendices contain examples of some practice policies. These examples are not individually approved or endorsed by the RACGP Council, or by the Standards. They are based on policies and practices from national and international sources. If practices wish to adopt any of these policies, they should be adapted or modified for relevance and applicability to the local context. 

1.2.1 Who will use this guide and why?

This guide may be used by practice owners, managers and support staff who:

  • are concerned about prescription drug abuse in their practice area and want to prevent a mishap
  • service a population with a high prevalence of mental illness, pain and/or addiction problems and want to ensure they provide the best possible care
  • have had an adverse event associated with prescription drug abuse and want to know how to prevent a recurrence
  • have doctors who have expressed concerns about what is happening regarding drugs of dependence
  • want to contribute toward reducing prescription drug abuse in their community.

This guide may be used by GPs who:

  • rarely sees patients who abuse prescription medication, but want to know more about the proper management and treatment of these patients
  • occasionally sees patients who abuse prescription medication, but uncertain of their legal responsibilities
  • felt unsafe during a consult with a patient with drug-seeking behaviour, and would like to take something to their practice manager to address this
  • saw an adverse event with a colleague, and would like to know how their practice and colleagues can manage this problem better
  • is starting in a new practice and would like a way of talking about the issues of prescribing drugs of dependence at the next practice meeting
  • works with other GPs who frequently prescribe drugs of dependence for conditions where other (safer/more effective) evidence-based therapies exist (eg insomnia), and is concerned about this practice and the risks associated with it, and would like some guidelines to discuss with them and implement in their practice
  • would like the support of professional colleagues and the RACGP in advising patients on the risks and benefits of use of prescribed opioids and be able to make an assessment that weighs the risks versus the benefits of continued prescribing and the skills to taper and terminate opioids when appropriate.

This guide may be used by medical students who:

  • were taught the harms associated with the use of benzodiazepines and opioids, yet have seen this in some practices.
  • This guide may be used by general practice registrars who:
  • are starting in a practice in their first GP rotation and want advice on how to prescribe safely
  • want assistance in implementing a policy of one prescriber for any drug of dependence
  • want to feel confident and supported in advising senior colleagues that they will not provide ongoing prescriptions for drugs of dependence to patients they do not know.

This guide may be used by a psychiatrist, alcohol and drug addiction specialist, chronic pain specialist, other medical practitioner, practice nurse, nurse practitioner, credentialed mental health nurse, psychologist, social worker, or allied health professional who:

  • is concerned about the prescribing habits of the doctors they work with and would like some guidelines to discuss with them.