No more opioids for chronic pain


doctor holding up a bottle of pills

Doctors at GP conference call for move away from “ineffective and unsafe” opioids to more active forms of pain treatment

As the RACGP conference kicks off this week, a pre-conference session has already generated some debate surrounding opioid prescribing and use among the population.

The session about managing chronic non-terminal pain explored how general practitioners can no longer rely on a quick fix for the complex problem.

“Opioids for chronic non-cancer pain are not an evidence-based treatment. Ineffective and unsafe,” said conference attendee Sydney GP Dr Carolyn Ee.

She called for a public health campaign against opioid use for chronic non-cancer pain, “especially with codeine restrictions in 2018”.

The GP17 session suggested that doctors choose active over passive management for chronic pain in their patients, encouraging activities such as walking, swimming, yoga and tai chi.

And the best way to prevent use of opiates for management of chronic non-cancer pain? “Stop starting them,” according to the presentation.

“Have you heard the phrase ‘genuine pain protects from opioid addiction’. It’s wrong. The two are not mutually exclusive,” said a Victorian GP and educator in the area of addiction medicine, in an adjunct GP17 session entitled “The drug seekers journey”.

The session on chronic pain also warned against use of benzodiazepines for sleep and sedation, with evidence showing they are ineffective for sleep and can cause dependency and withdrawal symptoms.

With evidence of GPs overprescribing S8s and S4Ds in some circumstances, GPs have been advised to create a structured approach to prescribing such drugs.

For example, in non-cancer pain, to have a policy not to provide the medicines: at the first appointment; with a phone request; without a proper assessment; and/or over the long-term.

According to RACGP guidelines, prescribing drugs of dependence should be seen as an adjunct to care, and not regarded as the primary treatment regimen.

“For many of the conditions which drugs of dependence are used, non-drug interventions are often more effective and have sustained results,” says the RACGP.

“Where there is good evidence for non-drug interventions, GPs should consider these as first-line therapy.

“GPs need to be aware of the evidence for allied health treatments and be able to offer these (in-house or through referral) to patients when they need them.”

Clinical pharmacist and pain educator Joyce McSwan agrees.

“The strong reliance on medication alone as therapy remains problematic as people are desperately looking for a ‘fix’,” Ms McSwan tells AJP.

“Pain management is about self-management. There may be no fix but life does not have to stop.  It’s about adopting a comprehensive plan and goal setting towards living life despite the pain rather than focusing on waiting for the pain to be relieved than living life again.

“Staged supply of opioids, or monitoring compliance with the appropriate use of adjuncts so opioids are reduced, are noticeable roles that pharmacists can play. Identifying possible dependency issues and navigating patients towards supportive options.”

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32 Comments

  1. Debbie Rigby
    26/10/2017

    “And the best way to prevent use of opiates for management of chronic non-cancer pain? “Stop starting them,”

    Now that’s a ‘common sense’ solution!!! 👍

    GPs will be challenged by consumer’s expectations for opioids including codeine for chronic pain, same as we are. But it’s time to have a discussion with local GPs to work out a collaborative plan and know the allied health services in the local area. Consistent messages will be the key to driving behavior change.

    • Jarrod McMaugh
      26/10/2017

      I recommend that pharmacists read Debbie’s articles on deprescribing as a support to having discussions with local GPs, and Karalyn Huxhagen’s articles on pain.

      Just like proton pump inhibitors that are started for a short-term issue but perpetuated because stopping causes rebound, many people on opioids should consider transitioning to other treatment (including non drug therapies) if done with skill and care. Patients need to be given realistic expectations on pain and treatments… Staying on opioids shouldn’t be the norm.

      • Jane Babin
        28/10/2017

        Fix the issue necessitating prescribing a proton pump inhibitor and no one will question the logic of cessastion. But you can’t. Not anymore than you can – OR WOULD IF YOU COULD – fix adhesive arachnoiditis, Ehlers-Danlo, trigeminal neuralgia, chronic Lyme, fibromyalgia, failed back surgery, etc ad infinitum. Withholding opioids is not being done with skill or care and the concept that a patient should transition to other treatment is simply an excuse, perhaps created in your teeny-tiny subconscious, for not being able to cure. It is a very REALISTIC PATIENT EXPECTATION that if a practitioner cannot cure an underlying painful disease, and there IS a treatment for the pain alone (i.e., an opioid) the patient should have it. But go on, keep validating your inadequacies by torturing patients. One day you will be the one considering suicide when this tide turns and you realize how immoral your actions have been.

        • Sue
          29/10/2017

          It’s simply nothing more than another form of torture… I don’t they think everything’s been tried do they really think that pain meds was the first course of action? I mean come on.. it truly is nothing but a form of torture what they’re trying to do especially in the United States. Trying to make us believe we all have an imaginary pain and we just have to deal with it those are unrealistic ideas

      • JayJay
        28/10/2017

        I recommend you getting kicked in the nuts all day long and then maybe you can try some yoga afterwards. I have CRPS. It is incurable and it feels like I’m being dipped into a vat of frying oil all the time. My small dose of opioids gives me a little bit of relief so I can try to be with my family. The alternatives do not always work effectively. 5 knee replacements from a doctors mistake of ignoring my pain which turned into an infection has ruined my life.

    • Jane Babin
      28/10/2017

      Only consistent ACCURATE OBJECTIVE UNDISTORTED information is worth the paper it’s written on. Ping back when a kangaroo rips off your arm and because of the narrow-minded, unsubstantiated balderdash being dispensed like Jim Jones handed out Kool-aid and the cult-like following of this opioiphobic rhetoric you and far too many of your so-called professional peers have bought into hook line and sinker, all they will give you is a bag of ice, some acetominophen and a yoga lesson. Let’s see how you do with the “consistent message” that your arm doesn’t really hurt and that you need to “drive home” the behavior change of learning to live with it.

    • Sheila Rogers
      28/10/2017

      its not the meds its the dumb Fs that miss use it Ive been on pain meds for 17 years and guess what Im still alive I didnt over dose of shit I take my meds right so Im still the druggie because you couldnt help your kid we are not perfect but dont take your failure out on everyone else

  2. jason northwood
    27/10/2017

    Let’s monitor the PBS use of PanadeineFt from 1 Feb 2018 and see what happens

  3. Aussie Cable
    27/10/2017

    I am a chronic pain sufferer, and if you do this, I will kill myself (a guarantee of suicide rates skyrocketing, oh wait, maybe that’s what you want to do), because you fools who sit at desks, don’t understand what pain is like, why you may ask? You don’t have it yourself.

    I have spinal stenosis (and other injuries), so you think walking, swimming, and yoga is something I can do? No I can’t, and when I did, it was the root cause of a re-injury of my existing condition, which put me out for over 18 months……..

    Does not make political or common sense.

    Yeah – Good one guys!

    • knightbird
      27/10/2017

      I am the same as you.

      Without my pain relief I would commit suicide. I can barely cope with the pain I do have while on medication let alone trying to go without them.

      I can see where a prescription may not be needed in the beginning of ones journey but many people with chronic pain are on opioids because nothing else has worked.

      These so called do gooders piss me off!

      • Aussie Cable
        27/10/2017

        Hi Knightbird

        I empathize with you and understand with the suffering with chronic pain. I do hope these fools wake up and smell the real world of crap soon.

        God Bless

      • Sue
        29/10/2017

        Exactly

    • Sheila Rogers
      28/10/2017

      they dont give a shit about us its all about the government and what they want to control

    • Sue
      29/10/2017

      They’re trying to convince chronic pain sufferers that people have imaginary pain.. that’s what they’re trying to sell now… this all started with the DEA a few years back actually more than a few years back because of the fucking assholes out there that ARE NOT in pain anymore they take pain meds to get high. Or they’re still in pain but they want to get high on their pain meds personally I don’t get it but that’s how it is so thanks to them this is one of the reasons this started the other is the assholes out there that sell their pain meds. I don’t get any sense of highness from my pain medicine I just get pain relief.I DONT WANT ANY SENSE OF HIGHNESS Takes my pain level from 8-10 down to a 5-6 does it take it all away?? hell no it just makes it bearable and allows me to have a better quality of life there is other conditions that cause severe pain besides freaking cancer I’ve had cancer and this is way worse than the cancer pain ever was thank you very much ..and I do other things to try and make the pain better like I go and do swimming exercises for my Very progressed ankylosing spondylitis it is severe pain not just in the SI joints and Lumbar but my whole entire spine and both shoulders 24/7 for the last 15 years!! A progressive disease it’s not going to go backwards and it sure as hell isn’t my fault that it wasn’t diagnosed decades ago like it should have been chalk it up to crappy ass Dr’s if you don’t think everything’s been tried your nuts failed with TFN blockers probably cuz I’m too advanced. That’s what the last rheumatologist said but I don’t want to believe that so now I’m trying IL- 17 drug at my request but nothing yet wish me luck on that then I wouldn’t need that nasty ass fucking pain pills I don’t like pain pills I never have!!! but when you have a systemic disease because the pains just too damn severe you cannot function.. without them I can’t go do any type of swimming exercises in a heated pool I can’t walk I can’t do anything with the out pain meds because the pains just too severe and the disease process itself I still have a very difficult life even with pain medicines don’t think for one instant I don’t..for 34 years this crap did not affect my daily living till I started getting fractures in my spine.. let’s talk about that a minute how that first fracture wasn’t seen for 8 years after the fact.. I kept telling the lovely state of Mississippi it was broken they did every kind of film imaginable apparently they don’t know how to take a reed films in that state ..I just got to feel the constant throbbing and when it was finally address with radio wave albation.. that I wanted years earlier I might add but my pain Doc’s didn’t do that.. it took away that constant throbbing in that one part of my spine away 14 years later but that’s just one little part of the spine at the L3 oh and let’s talk about since that wasn’t diagnosed. Was not addressed when it actually happened I also have scoliosis which is mechanical so not only am I deformed horribly from the Spondylitis but I’m deforming that way from the scoliosis which is mechanical by the way until the spondylitis all progressed that’s not to say I didn’t have pain that came and went but not once did I take any pain medicine they call them flares mine just did not last that long and I just went on cuz I’m a pretty tough person but even a tough person can only take so much freakin pain on a daily basis.. it’s all started with the DEA guys several many years back because of assholes that abuser pain medicines or they sell them I’m not even able to go do my swimming exersizes. Or any walking or anything at all because the pains too goddamn severe if No pain meds. .. so this is nothing but a bunch of propaganda and then the media gets on there and fuels the fire even more the truth of the matter is only 1% of people in chronic pain ever get hooked on pain medicine that’s the real truth.. we DON’ T have imaginary pain this is real. This is what they are trying to get doctors to believe now.. now there’s pain Doc’s out there that all they do is injections no pain pills come on if injections work for everybody would be a pain free world now wouldn’t it they’re fully aware that they don’t always work for some people I was told that years ago..by a couple honest ones that aren’t just trying to make every penny they can from injections.. if anybody wants injections to work its us people that are suffering in horrific pain I mean come on.. I don’t know if any of the rest of you have noticed but most of them don’t use the Pain Scale anymore which is totally ridiculous I wondered what happened to the Pain Scale at pain management doctors and I was reading about it a big article more has to do with this all this propaganda just a few weeks ago.. wonder how many of those people making these rules have ever had chronic pain?? I bet that would be a big fat zero. I’m not talking about some kind of pain from some surgery you had that will go awayeventually or something like that I’m talking about chronic pain that’s Relentless that never stops when you have like a condition like me there’s many others out there When doctors are getting fired and pharmacies are getting sued over handing out too many pain scripts it’s got doctors and pharmacists alike scared they’re going to lose their freaking jobs that’s what this whole fucking thing is about you guys open your eyes I don’t live under a rock.. and you’re right there will be Mass suicides but maybe that is what they want…they talk about people dying from their pain medicine shit there’s so many medicines that can cause adverse reactions kill you in certain pain meds are known to cause problems in SOME patients that’s the KEY WORD it doesn’t mean everybody is going to have problems.. just like when vioxx was on the market NOT everybody got a heart attack that took it I sure as hell didn’t I hated it when they took that off the market I was still able to work then that’s all I was taking and I haven’t progressed to what I am now that’s when they thought I just had osteoarthritis an unstable back from degenerative issues LOL but it doesn’t happen to everybody that takes them.. the other thing they’re trying to come up with their propaganda is that people are taking way too many and they’re having Mass suicides that’s a bunch of propaganda Mass suicides happened when you can’t get out of the freaking paint no matter what you do.. and if you’re taking like you’re supposed to that shouldn’t be a problem either I’ve never taken more than I was supposed to in fact I take less than I’m supposed to just because I hate freaking pain medicine and I don’t want any sense of highness and if I can get the same relief with a lesser dosage that’s what I do.. I would bet that’s what most people do that have chronic pain …I’ve never liked having to take it at an early age of 22 when I had malignant melanoma stage 3 and was given 6 months to live. Crutches for a year-and-a-half because the skin grafts would not take that kept turning to mush I don’t have a scar.. I have a huge surgical deformity in the bottom of my leg from my knee to my ankle but I did what I was supposed to do I did my physical therapy I had to go to the therapist 7 days a week he had to open on Sunday for me so that I wouldn’t ever have a limp guess what I never did.. as soon as the pain went away those things went in the trash.. I don’t like pain medicine but since my Spondylitis wasn’t ever fucking diagnosed like it should have been years and years decades ago and it still wouldn’t be diagnosed if all my research that led me to a top rheumatologist for this disease. When I was 55 years old.. MY ONSET was AGE 12.. did I have pain with it over the years hell yeah but I never took pain medicine I just kept going but it wasn’t my whole entire spine and it wasn’t constant like it has been for 15 years… I’ve done physical therapy I think 10 or 11 times at my request I’ve had every kind of injection you could think of that don’t do shit come to find out no wonder they don’t work there a of little benefit to my disease. I have tried all kinds of natural things like tumeric curumin standardized capsules and fish oil capsules Devil’s claw.. all to reduce inflammation and pain.. and let me point out something else I was always an active person that’s probably one reason why I didn’t progress much faster I always worked out either with aerobics or Jazzercise classes but I never ever was a swimmer.. but I do swimming exercises in a heated pool that’s the only thing I’m able to do and stretching exercises up on my bed let’s see I haven’t been able to get up out of a bathtub for 15 solid years I’m not a big fat person nor have I been able to get up off the floor can’t handle what more than about 4 stairs. I could go on and on the things I have tried mostly at my request or on my own for the last 15 years trying to get out of this horrific pain that I’m sorry to say you people can’t even imagine what it’s like because if you could you wouldn’t be selling this propaganda bullshit.. you tell me what else do you think I could try that hasn’t been tried over the last 15 years you tell me cuz I’d be curious to know.. like I said wake up guys I don’t live under a rock this is the real truth about all this bullshit going on.. I’m sorry to say it’s just keeps getting worse year after year and yes there will be Mass suicides because our pain will not be addressed anymore..

  4. Candie
    28/10/2017

    All of this sounds absolutely ridiculous first of all patients that have been on a opioid pain medication 99.9% I’m willing to bet have exhausted all of the possible treatments for their condition.

    Before my doctor choose to prescribe opioids I had done Physical Therapy three separate times I’m not talking about appointments I’m talking about the entire round of physical therapy appointments acupuncture which I had to pay out-of-pocket for Chiropractic services I tried NSAIDs anti-seizure meds antidepressant meds and he psychotic meds I found it really puzzling how doctors would write prescriptions for psychotropic medications for off label use for pain before he would write a prescription for a safer medication that was designed solely to treat pain and didn’t come with the host of side effects that these other medications did. However I did everything my doctor son tried everything the doctor told me to even took money out of my own pocket to pay for holistic healing acupuncture yoga classes but no matter what I did it didn’t put a dent in my chronic pain.

    You speak about people going back to living without waiting for the pain to be gone what you seem to be naive to is that we can’t live we can’t even move. Before pain meds I was completely bedridden I could barely make it to the bathroom on my own. I would lay in bed sometimes 10 hours waiting for my husband to come home with something to eat I couldn’t even stand long enough to make a peanut butter sandwich in the kitchen. What you are basically are asking is the equivalent of telling a paraplegic to get out of the wheelchair and live their life. That they could walk if they really wanted to and they were just making a choice to remain bed-bound. This is not a choice that we made our choice was taking away the day a chronic illness took over or a accident the negligence of somebody else caused an injury that has never healed.

    Addicts choose this life they choose to get high we didn’t choose to get sick and we certainly aren’t milking it. The way the sick and disabled I treated in this country is deplorable.

    Everyone keeps saying that studies show that long-term opioid uses an effective at treating chronic pain however if you talk to just about any chronic pain patient they will all tell you that they are better off on the medication than they were before they were able to receive it. There are people working today millions that will not be able to work tomorrow if they’re pain medication is taken away and I hope that you are aware of the consequences of this action because the cost on society is going to be enormous. The number of people applying for welfare and disability will go up on an unprecedented scale. Let’s not forget the number of patients suicides something that is already happening and is being swept under the rug.

    Personally I do not understand why someone who has gotten in a chronic illness or been the victim of somebody else’s negligence should have to suffer and even die to save a drug addict. Is there limes worth more than mine or somebody else who didn’t choose that life? And you know what if I really thought that doing this would save lives then maybe I would be willing to suffer a little but this approach is not going to work and was flawed from the start. While the government Cuts back the number of opioid prescriptions two people with a legitimate medical need for them no action is being taken with regards to opioids coming over the Border. It is now easier to go down to a street corner and get opioids or cheap heroin which is even less expensive than it is to get a prescription. Let’s be real here Alex aren’t sitting in a pain management clinic for 4 hours going back every week for pill counts and drug tests. Even if they did manage to sneak their way into a Pain Management Facility the doctors will quickly pick up on the fact that they are abusing their medication and they will be put out. The four majority of deaths are caused by medication that has been bought on the street not prescribed by a doctor another fact that is constantly skewed in the media to fit the government’s agenda.

    Also the fact that the suppose of studies that these guidelines were based off of or flawed and there was no actual monitoring or study of long-term opioid use. The longest study only lasted 12 months.

    If you ask me this is just some conspiracy to get opioids off the market probably because big pharmaceutical is coming out with the next big thing that probably is more expensive and Congress people will be getting their kickbacks and they can do all this evil stuff under the disguise of saving America from opioids what a noble cause.

    • Dianne MacKay
      28/10/2017

      Very well said.

    • Jenny
      28/10/2017

      Completely agree, you took the words right out of my mouth! I’m like you, have tried EVERYTHING out there that’s an alternative to opioids. I still incorporate some of those things into my treatment plan. However, without opioids I’m completely bedridden. The way we are being treated is barbaric and we aren’t even being given the humane treatment that animals get. I’m terrified of the future as it seems it’s only getting worse.

      • Sue
        29/10/2017

        You are exactly right!! Nothing more than a different new form of torture that they’re wanting to do to chronic pain sufferers

  5. Jane Babin
    28/10/2017

    If opioids are ineffective for chronic pain, how do you explain the clinical trial results for Belbucca and Brutrans OPIOIDS, both FDA approved for long-term use for chronic pain? Trials demonstrating efficacy were continued for up to a year in hundreds of patients, which is well beyond the clinical definition of chronic pain. Buprenorphine is no different than any other opioid in terms of demonstrating the fundamental efficacy of this class of drugs for the indication of chonic pain. In fact, it has a ceiling for analgesia, which means that if buprenorohine is effective for chronic pain, than other, more effective opioids are even more so. Read the prescribing information and clinical trial study data!!!! Stop spreading lies and following anti-opioid cult leaders like Andrew Kolodny, Jayne Ballantyne and the dubious CDC Debs Houry and Dowell. Didn’t they teach you idiots how to read and think?

  6. Louise Britz
    28/10/2017

    Whoever wrote this crap should be submitted to a blowtorch burn several times per day and be told to walk it off or breathe through the pain. After 8 months of that, we’ll talk again. 😡

    • JayJay
      28/10/2017

      And then do yoga afterwards. Lmao These people are absolutely stupid!

    • Sheila Rogers
      28/10/2017

      hell yeah well said

  7. Louise Britz
    28/10/2017

    I seriously think that the amount of suicides due to untreated pain will outnumber the amount of controlled prescription overdose of opioids for chronic pain patients.

    • Sheila Rogers
      28/10/2017

      its not the overdose of pain meds its the druggies that are mixing other drugs together

    • Lisa
      02/11/2017

      The problem is they are refusing to recognize the suicides as related to increased pain from reduced/removed pain meds (unless the person leaves a note stating such). They are saying they are from the ppl being addicted and now can’t get their fix so they kill themselves. Thus, the figures are being skewed AGAIN so they don’t show the REAL reason ppl are killing themselves.

  8. Sheila Rogers
    28/10/2017

    this is bull shit no one knows ones pain and the government is taking control of us all

  9. linda
    29/10/2017

    Not everyone who takes opioids are addicts. There are many people who just have chronic pain that will never go away and the benefits of opioids help take that pain away or at least help get through the day

  10. Di
    29/10/2017

    There doesn’t seem to be any mention of chronic pain that results from chronic underlying conditions, and what the recommendations are for that. The medications available for my condition are KNOWN (with many research papers and trials to back them up) to often result in only a 20% to 40% (at most) improvement in pain and other symptoms. Access to GOOD pain relief on top of that means the difference between being able to function enough to work, or having to stop (and so then be reliant on government support). How is that helpful to anyone? I think there’s too broad a brush being swept across the concept of ‘chronic pain’ — it won’t be too long before GPs have to jump through so many hoops to prescribe the right medication for an individual that they’ll stop trying.

  11. Dr Evan Ackermann
    29/10/2017

    The RACGP have released opioid prescribing guidelines for acute
    and chronic pain – found here https://www.racgp.org.au/your-practice/guidelines/drugs-of-dependence-c/

  12. Shannon Crawford Tuten
    29/10/2017

    this is the most ridiculous thing I have heard and will KILL chronic pain patients, how do you explain then over 300 days as an inpatient in 2.5 yrs, over 100 admits, then I found the right pain combination taht includes opioids and I can handle things at home with my meds and NOT by taking extra, since opioid therapy I have been admitted 2 times in over 10 years but tell me again how it doesn’t work. I guess they want chronic pain patients to suffer and die form suicide, what happened to “first do no harm”. shame on you for recommending patients suffer instead of treating pain adequately,

  13. Fieldsie
    29/10/2017

    MANY chronic pain patients in the U.S. have taken their lives due to untreated or under treated pain. This is GENOCIDE, TORTURE & INHUMANE!! CDC used biased data and there were NO pain experts on the so called “Expert Panel” AN addictions expert has NO business telling Pain Drs how to treat their patients. ONe size fits all is NOT working nor is scientifically sound. Journalist writing about this should really do their due diligence and research the WHOLE story. Chronic pain patients are being punished because some people have became addicted to ILLICIT drugs it is NOT prescription drugs fueling this crisis it is HERON and ILLICIT Fentanyl!!! These Hitleresque policies are KILLING people!

  14. Good choice. We need to consider more the non opioids options

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