Opiate and Controlled Drugs Policy

At Wellspring GP Surgery, our priority is to work with patients to provide safe and evidence-based care. We follow national guidance regarding the use of controlled drugs.

What are controlled drugs?

Controlled drugs are medications closely regulated by the government because they carry a high risk of addiction, abuse and potential harm.

These include:

• Opioid painkillers: morphine, oxycodone, fentanyl, tramadol
• Gabapentinoids; pregabalin and gabapentin
• Benzodiazepines and Z drugs; diazepam, temazepam, lorazepam, zopiclone, zolpidem.

Our approach

We are careful about starting controlled drugs and will only do this for conditions where national evidence advises it is safe to do so.

We aim to improve patient safety and overall health by slowly reducing controlled drugs where possible.

Lost or stolen medications

Replacement prescriptions for lost, stolen or spilled controlled drugs will generally not be reissued.

This policy is in place to reduce the risk of misuse, diversion and accidental overdose.

If medication is reported as lost or stolen, we will fill in a 'lost prescription contract’ with you.  We will ask you for a police crime reference number if your prescription is stolen.

We may need to move you to weekly or even daily prescriptions to improve safety.

Opiates

Opiates are a group of painkilling medication that includes codeine, tramadol, dihydrocodeine and morphine.   Sometimes an opiate is combined with paracetamol, e.g. co-codamol is codeine and paracetamol together in one tablet.

Opiate medications used to be commonly prescribed for long-term or chronic pain.   But we now know that they can cause more harm than good and there has been a change in approach to how these medications are used. 

What are the risks of long-term opiates?

There is a long list of risks, but these are a few of the most important: 

• Side effects, e.g. constipation, nausea, drowsiness
• Dementia – multiple large studies show a link between long term opiate use and increased a significant increased risk of dementia
• Falls
• Potentially life-threatening side effects such as breathing suppression, heart problems and a higher overall risk of death
• Worsening of pain as nerve endings are ‘sensitised’ to pain
• Immune function reduced causing higher risk of infections
• Libido reduced for both men and women

Addiction

When should opiates be used?

• For short term pain e.g. after an operation
• Poorly controlled cancer pain

Opiates should not be used long term for:

• Chronic non-cancer pain, e.g. back pain, fibromyalgia, arthritis.

What can be done to help chronic non-cancer pain?

Non-opiate painkillers have a role, support with pain from our social prescribing team, exercise referrals, physiotherapy, weight management, talking therapies, and hospital pain clinic.

What is the Wellspring GP Surgery policy regarding prescribing of opiates?

We work as a team to keep our prescribing as safe as possible. We follow national guidance that opiates should not be routinely prescribed for chronic noncancer pain.  We will aim to slowly reduce long term opiate prescribing for patients with chronic pain and will support each patient through this.

If you are discharged from hospital on a new opiate medication, this will not be put onto repeat prescription.  You will be sent a text message asking you to book an appointment to review your pain if you need to.

What if you are already taking Opiates?

• If you join our practice and already take these medications for non-cancer pain, we will work with you to review and gradually reduce your dose
• This process will be done safely and supportively; we will offer guidance about other things that can help chronic pain

• We understand that changes to longstanding medications can be frightening or difficult
• We will work as a team with you to try and support you
• We will make decisions with you, giving you some control and trying to go at your pace

By registering with the practice, you acknowledge and agree that:

• Prescribing of opioids and other high‑risk medicines will be regularly reviewed in line with national safety guidance
• Where appropriate, your clinician may recommend a gradual reduction of these medications to improve your safety and long‑term health outcomes
• Any dose reduction programme will be discussed with you and supported by the clinical team
• Repeat prescriptions for these medicines may be limited, closely monitored, or stopped if deemed clinically necessary
• You will not seek duplicate prescriptions for controlled or high‑risk medicines from other providers without informing the practice
• Our priority is your safety and well-being, and we will work with you to ensure any changes to your medication are made as safely and comfortably as possible.

Sean’s story

Sean describes how he started to use opiate based pain killers and his journey to life without them.

Sean's Story - There is another way

Gabapentinoids

• Gabapentinoids are controlled drugs and include gabapentin and pregabalin. 
• Knowledge about pain medications is always changing and we now recognise gabapentin and pregabalin as 'high-risk' medications that can cause serious / life threatening side effects. This is more common in people over the age of 65y and in those also taking opiate medication (codeine / tramadol /morphine).
• Wellspring GP Surgery will only prescribe gabapentinoids for licenced indications; Epilepsy, nerve pain and sometimes generalised anxiety disorder
• If you are prescribed a gabapentinoid for an indication that is not licenced, we will aim to slowly reduce and stop your medication.
• Gabapentinoids are not prescribed for fibromyalgia, there is no evidence that they work and the risks are too high
• Gabapentinoids started in hospital will not automatically be put on repeat prescription, you will be asked to discuss whether they are working with your GP or a pharmacist.

Please open this link for more information about pregabalin/gabapentin safety