Tag Archives: Drug and Alcohol Services

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