Community health

New guidance introduced to restrict prescription of ‘harmful’ painkillers

By - Primary Care Journal

New guidance introduced to restrict prescription of

In the latest National Institute for Health and Care Excellence (NICE) guideline on the treatment of chronic pain, General practitioners (GP) are told not to prescribe opioids and other medicines like paracetamol to patients due to them being potentially harmful and addictive.

Instead, NICE has recommended that GPs prescribe exercise programmes, Cognitive Behavioural Therapy (CBT), acupuncture or certain antidepressants, in line with the Government guidelines.

The draft guidance reveals that the treatment of chronic pain by commonly prescribed medicines, including opioids and gabapentinoids, has limited evidence of effectiveness. However, there is sufficient evidence that they could be ‘harmful’ to patients and cause addiction.

Eytan Alexander, Managing Director of the drug addiction firm UKAT, welcomed the news, stating: “finally, it is written in black and white the dangers and addictive nature that prescribing opioids and other ‘pain relief’ drugs can have on patients. ”  

The drugs no longer allowed to be prescribed by GPs for managing chronic primary pain to anyone over the age of 16 are:

  • opioids 
  • non-steroidal anti-inflammatory drugs
  • Benzodiazepines
  • anti-epileptic drugs including gabapentinoids
  • Paracetamol
  • Ketamine
  • Corticosteroids
  • antipsychotics

Drug addiction treatment experts have welcomed this change in guidelines, saying that prescription drug addiction has risen by 40 per cent in the last 18 months, with the majority of those seeking treatment being female.

NICE guidelines are advising GPs to explain the ‘risks of continuing’ to those already taking any of the above medicines, and also warn about withdrawal problems that could occur should a shared decision to stop taking the drugs be made.

NICE has also agreed that short-term use of opioids could be harmful for a chronic condition, due to its addictiveness.

"GPs will need to be supported and resourced well enough so that they can spend a longer amount of time with their patients in order to provide a more holistic, safer treatment plan for chronic pain. One that doesn’t lead to addiction,” added Mr Alexander.

NICE draft guidelines follow last year’s Public Health England’s review into prescription drug addiction which revealed that one in four adults in England received a prescription for antidepressants, opioids, gabapentinoids, benzodiazepines or z-drugs in the previous year.