The over-use of and over-reliance on prescription opioids for the management of chronic pain and the associated adverse events for the individual and wider community are well recognised issues in Australia and internationally. In Australia in 2016–17, 3.1 million people had 1 or more prescriptions dispensed for opioids (most commonly for oxycodone); in comparison about 40,000 people used heroin and about 715,000 people used analgesics and pharmaceutical opioids for illicit or non-medical purposes. In 2016, pharmaceutical opioids were responsible for more opioid deaths and poisoning hospitalisations in Australia than heroin.¹

In Australia, the burden of caring for patients with chronic pain is borne predominantly by general practitioners. Caring for patients with chronic pain is complex and strong clinical governance in the management of patients with chronic non-cancer pain requiring opioid therapy is extremely important in the general practice setting.² The opioid therapy patient agreement is an important element of such clinical governance and engenders opportunities for shared decision making, enhancing outcomes for patients and the general practice and can serve as a safeguard for patients and health professionals. The agreement also serves to provide patient education about opioid therapy and the broader biopsychosocial model of chronic pain. It also facilitates mutual agreement about the treatment course and establishes terms of monitoring for safe opioid use. In particular, the patient agreement serves as a lever in shifting the focus of the management of the individual’s chronic pain from relying on medicines to introducing and amplifying non-drug strategies wherever possible. An important example of this is the use of opioids for the management of pain associated with knee and hip osteoarthritis, for which lifestyle interventions such as weight loss and activity are considered first line management strategies³, but for which the prescription of opioids is high in Australia.⁴

This presentation will describe the experiences of a general practice which has successfully integrated an opioid therapy patient agreement into the practice’s clinical governance framework for caring for patients with chronic pain. It will provide insight into how to design and implement an opioid therapy patient agreement, including strategies of how to engage patients in the process through embedding the agreement into a chronic pain care plan. The case based presentation will include discussion of patient-centred outcomes achieved through the implementation of the agreements, the experiences of the GPs and the practice as a whole, and challenges encountered during the process and means by which these may be overcome.

The presentation is an example of translating evidence into everyday general practice, to reduce the over-reliance on opioid therapy and the medicalisation of conditions that may be best managed with non-pharmacological interventions.

References

1. Opioid harm in Australia. www.aihw.gov.au/reports/illicit-use-of-drugs/opioid-harm-in-australia/(accessed 6/5/2019)

2. RACGP Clinical Guidelines: Prescribing drugs of dependence. www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/prescribing-drugs-of-dependence (accessed 23/04/2019).

3. Therapeutic Guidelines Australia: Rheumatology. March 2017.

4. Australian Commission on Safety and Quality in Health Care. Osteoarthritis of the Knee Clinical Care Standard, 2018.