How do we find and treat the ‘hidden cohort’ of patients dependent on opioid painkillers? 

ORAT – Opioid Risk Assessment Tool (ORAT)
‘People who are addicted to painkillers are a really complex group,’ says Jon Royle, chief executive of the Bridge Project. ‘You’ve got people who are prescribed painkillers and who are also using illicit drugs and have complex addiction issues. And you’ve got other people who were prescribed them to manage pain legitimately, so where the pain relief is required and where it has become an actual addiction problem is no longer clear cut.’ Among the patient group are those with complex emotional, psychological problems, who are taking anything to make themselves better, he explains. ‘So there are a lot of issues to work with when you get into this cohort.’

At the Bridge Project, based in Bradford, staff had experienced success in running a benzodiazepine withdrawal service for the past seven years, targeting patients in primary health care and GP practices.‘Doing that kind of work in primary care, we were also coming across a great deal of patients addicted to prescribed painkillers as well,’ says Royle. As with the benzos, ‘these patients are never going to roll up at an addiction treatment service on the high street – but that doesn’t mean that there’s not tens of thousands of them out there, people who’d say “I’ve never been near an illegal drug in my life”.’

So they decided to develop a model along similar lines to the benzodiazepine scheme, going into GP practices with the highest levels of prescribing and using the Opioid Risk Assessment Tool (ORAT) – which sits alongside the patient record system, Emis – to screen patients. They then worked with GPs to review the patients’ prescribing and liaised with specialist doctors and addiction practitioners to offer treatment, detoxification and support such as cognitive behavioural therapy (CBT). The response has been ‘really good, with far better outcomes than with opiate users’, says Royle – success he attributes to planting the service within primary care.

ORAT – Dependency detector

Prescription drug addiction: government launches investigation

Public Health England will review prescription of medicines including opioid painkillers

The government has ordered an investigation into the growing problem of addiction to prescription drugs such as painkillers and medicines to treat anxiety and insomnia.

Steve Brine, the public health minister, has acted after it emerged that one in 11 (8.9%) patients treated by the NHS in England last year was given a drug that can induce dependency.

Fears about excessive prescription has also been boosted more than 100% rise in the number of antidepressants prescribed in England over the last decade and the fact antidepressants prescribed in England over the last decade and the fact that prescription of addictive medicines has increased by 3% over the last five years.

Full story – https://www.theguardian.com/society/2018/jan/24/prescription-drug-addiction-government-launches-investigation

Antidepressant Seroxat tops table of UK drug withdrawal symptoms

Seroxat, the British-made antidepressant which outsells Prozac, causes more people distressing withdrawal problems when they try to stop taking it than any other drug in the UK.

Paroxetine, also known by trade names including Paxil and Seroxat among others, is an antidepressant of the selective serotonin reuptake inhibitor class.

Formula: C19H20FNO3
Trade names: Paxil, Pexeva, Seroxat, others

The committee on the safety of medicines, which receives reports of drug side-effects from doctors and pharmacists, has received an avalanche of complaints about Seroxat, one of the class of drugs known as SSRIs (selective serotonin reuptake inhibitors). The SSRIs, including Prozac, have always been marketed as safe medicines which are supposed not to cause the dependence problems that emerged with older drugs such as Valium and Ativan.
Seroxat – known generically as paroxetine – leads the top 20 table of drugs causing withdrawal problems, with 1,281 complaints from doctors under the “yellow card” scheme set up for the reporting of medicines’ side-effects. More reports have been filed about Seroxat than about the rest of the top 20 put together.

Full story – https://www.theguardian.com/news/2002/jul/27/uknews