Opioid prescribing and medical education: can primary care fill in the gaps?

[摘要] Prescribing opioids has increased since 1998,1 with 12.8% of England’s population having had a non-cancer opioid prescription dispensed over a 1 year interval. Approximately 50% of these patients take their prescription for at least 1 year.2 With 43% of adults currently living with a degree of chronic pain in the UK,3 it is likely, and concerning, that overprescribing of opioids will continue. An audit of opioid prescribing on a GP placement inspired me to reflect on how medical education is failing to prepare the next generation of prescribers to be ‘opioid aware’.IS MEDICAL EDUCATION TOO OUTDATED? Pain education is insufficiently presented in medical schools given the burden of pain in the general population. Further, pain education is largely fragmented throughout the curricula, with no standardised approach to tackle such a nationwide issue.4 In my experience, most clinical pain teaching is based around the World Health Organization (WHO) Analgesic Ladder (https://www.who.int/health-topics/palliative-care, which is cancer-based and should not be used to manage chronic pain — a very different type of pain), pharmacology, and palliative care. Teaching included the benefits and the harms of opioids but only seemed to be scratching the surface of pain management. Further, teaching critically ignored the emotional pull of balancing the desire to help a patient in distress without causing more harm such as addiction, tolerance, and worsened pain—opioid-induced hyperalgesia. Such an ethical dilemma was never debated during medical school but is clinically relevant in the day-to-day decisions doctors have to make. More teaching is needed on managing patient’s expectations and informing them of the potential for addiction via the use of validated screening tools. All prescribers need to be aware of the services available for addiction, including that which is iatrogenic. Without action, this will leave the next generation of prescribers uninformed of the complex reality of patients experiencing pain and how to appropriately assess and treat them.

[学科分类] 卫生学