Prescription drug dependence is always going to cause you a fair few grey hairs, particularly if you manage a patient list. This is partly due to the sheer number of patients affected – according to a 2019 Public Health England report, a staggering 1 in 4 people in England take prescription medicines with the potential for dependence and withdrawal. Long-term prescribing is also widespread, despite these drugs only being licensed and indicated for short-term treatment of acute conditions. These high levels of historical prescribing can be a daunting challenge to address in under-pressure primary care.
The 2022 NICE Guideline ‘Medicines associated with dependence or withdrawal symptoms’ provides some helpful pointers, but also has significant implications for us as prescribers. It’s clear we must be explicit with patients about the risk of dependency before prescribing, and patients already taking these drugs should be offered a supported withdrawal.
But how do we give that supported withdrawal the best chance of success? Sorry, cold turkey isn’t the answer. However, ‘The Five E’s’, proposed in helpful Guidance from the Oxford Pain Management Centre, provide some practical steps.
And if the 5 E’s fail and you don’t succeed first time? Don’t panic – life happens. Aim to stop any further escalation in the patient's dose, plan to attempt another reduction at a later date and clearly record the advice you’ve given.
Managing prescription drug dependence is just one of the clinical scenarios that we cover in the brand new ‘New to GP’ course on June 15th. We will share guidelines, tools and advice focusing on those high-risk or challenging consultations, as well as covering the softer skills and practical information to enable you to thrive as a recently qualified GP.
We hope to see you there!
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