Co-prescribing of Opioids and Gabapentoids in Primary Care

Jessica Henry, Sam Wright

Background

• Our practice prescribes more high dose opioids and gabapentoids than national average1

• Limited evidence of benefit in chronic pain2,3

• Risk of harm increases with co-prescription50% increase in opioid related death when co-prescribed with gapapentinoids4

Aims

Interventions

• Intervention: Increasing patient access to support from mental health and wellbeing coach. Educating patients about nonpharmacological ways to manage pain (e.g. exercise, mindfulness)

• Inclusion: Patients co-prescribed opioids and gabapentinoids. Selected a group of patients who’d already been invited by text (depression +/- chronic back pain +/- BMI >32)

• Exclusion: Undergoing treatment for cancer

PDSA cycles

Results

• Reduction in number of patients coprescribed opioids and gabapentinoids (baseline=42, cycle 1=25, cycle2=20)

Reflections and next steps

• Letters are an efficient method to contact patients and provide information

• Phone calls most effective way to engage patients in accessing support

• De-prescribing in chronic pain requires careful planning and collaboration with patient

• Next steps: wellbeing coach to book patients in with usual GP for de-prescribing consultation