Dependence Forming Medicines Practice Policy

Opioids (morphine-like medicines), pregabalin, gabapentin, benzodiazepines, and sedatives are dependency forming medicines.

Examples of these medicines include:

Opioids	Other Drugs of Dependence
Morphine	Pregabalin
Oxycodone	Gabapentin
Fentanyl	Temazepam
Buprenorphine	Nitrazepam
Codeine	Diazepam
Dihydrocodeine	Lorazepam
Tramadol	Zopiclone
Tapentadol	Zolpidem

Any new patients registering with the practice must inform the practice staff if they are prescribed any of the above medications.

The priority of the practice is to provide safe, evidence-based, and compassionate care. We follow the latest NHS and NICE guidance regarding medicines that can cause dependence.

If you are a new patient to the practice:

• It may take time to get accurate medical information about your condition. Until such information is available, your GP may choose not to prescribe any medication. It is our policy that GPs do not prescribe drugs of dependence until they have a full clinical picture.
• Your GP may decide not to continue prescribing an opioid medication or other dependence forming medicine previously prescribed for you. It may be determined that such a medication is not suitable. It is our policy that GPs do not prescribe drugs of dependence if they feel that previous prescriptions were inappropriate.
• Your GP will evaluate your condition and only prescribe an opioid of the strength necessary for you. This may be different to the drug you had prescribed at your previous GP Practice.
• If you register with the practice and are already on these medicines for non-cancer pain, we will work with you to review and gradually reduce your dose.
• The practice does not start patients on long-term opioids for non-cancer pain. Evidence shows that, for most chronic (long-term) non-cancer pain, these medicines do not improve pain or quality of life in the long term and can cause significant harm.

General practice standards:

• If the decision to prescribe is taken after a shared discussion of goals, plans, risks and benefits, you may be required to confirm your consent in writing.
• You will be asked to complete the Opioid Management Plan: Treatment Agreement that will detail our practice’s expectations when prescribing drugs of dependence. This agreement details your responsibilities as a patient taking a drug of dependence; any prescriptions issues; advice on taking your medications; how we will monitor your care; and the standards of behaviour that are expected.
• Patients may need to acknowledge that their care requirements may be complex, and that referral for on-going care for all or part of your healthcare may be required. It is our practice policy that patient care is matched with the level of complexity.
• Patients are reminded that we have a zero tolerance on issues relating to staff abuse.

If you are being prescribed one of these medicines, the practice needs to have an agreement in place that protects both you and the practice.  In completing this online form, you (the patient) agree to the following conditions regarding the prescribing of these drugs:

• I understand that regular use of opiates, benzodiazepines or sedatives is highly addictive and can cause serious harm to my long-term mental and physical health
• My GP is responsible for safe prescribing of my medication
• I will not use my medication other than at the dose and frequency prescribed
• I am responsible for the security of my medication. Due to the nature of these drugs, any lost, misplaced or stolen medication or prescriptions for medication will not be replaced and must be reported to the police.
• I will only obtain my medication from my GP or another clinician authorised by them, or a relevant specialist. I understand that no early prescriptions will be provided.
• I will read the patient information leaflet that accompanies my medication and I will let my GP or specialist know if I experience any ongoing/intolerable side-effects.
• As a possible dependency is important with this medication, I will inform the clinician signing this agreement of any present or past dependence on alcohol or drugs that I may have had and of any illegal activity relating to drugs in which I have been involved.

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