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Feature Article

Opioid prescribing in general practice: a proposed approach

Milton L Cohen, Alex D Wodak
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GPs can facilitate opioid prescribing in their practices by following the five principles of opioid prescribing, utilising the five tools for assessment of use and using the five criteria for evaluating outcomes of an opioid trial.

Key Points

  • The experience of chronic pain has biological, psychological and social contributions, each of which you need to assess.
  • Drug therapy for patients with chronic noncancer pain is only part of a multifaceted, if not also multidisciplinary, treatment approach. If drugs are needed to treat patients with chronic noncancer pain, ensure you also pay attention to psychological and social stresses.
  • Ensure opioid pharmacotherapy for patients with chronic noncancer pain is always an ongoing trial of therapy.
  • Be aware of the regulations regarding opioid prescribing in your jurisdiction and of the ‘rules’ regarding PBS-subsidised opioids.
  • Document any opioid trial carefully and if it is not working start tapering the dose to zero. If you are not sure what to do, ask for advice from a colleague experienced in chronic pain, a pain specialist, an addiction medicine specialist or a psychiatrist.