- All general practices should have a practice policy on prescribing drugs of dependence. Register with Prescription shopping information service
- Primarily opioids and benzos
- Deaths commonly combinations and with alcohol – cause respiratory depression
- High dose opioids >50mg per day associated death from unintentional overdose
- Can call prescription shopping service – doesn’t capture non-PBS prescribing though
- Assess – biopsychosocial, make contact with previous treating doctors, formulate treatment plan
- Monitor frequent review appointment – assess function and quality of life, not just singe symptom
- Clearly document
- Risk factors for dependence
- Drug availability, concurrent mental illness, use of other substances, negative life events, unemployment, social isolation, substance using peers
- If prescribing consider
- Set clear time boundaries – will not be long term
- Control quanitites
- Control dispensing
- Don’t do private or increased quantity
- Request they get scripts from the same pharmacy
- Patient needs to see the same GP for all reviews associated with the prescription
- No telephone requests for extensions or lost scripts will be given
- Opioid contract
- Opioid dependence
- Trial of controlled prescribing
- Opioid substitution – methadone or buprenorphine
- Consider offering naloxone
Related