The letter about appropriate access to opioid-based analgesia from Drs Gallagher and Hawley [BCMJ 2020;62:315] notes the steady decline in the proportion of people over 65 being started on opioids and the harm that such a reduction has for seniors. Mention is made of patients’ regular physicians refusing to prescribe opioids, along with the unlikelihood of seniors having problems with addiction after being started appropriately on opioids, and the consequent irrelevance of concerns about the toxicity of preparations that might be obtained from the illicit drug market.
As a senior and a retired family practitioner, I have personally noted the reluctance of younger physicians to prescribe codeine-containing preparations, and I have heard the suggestion that a drug contract should be signed before doing so. The impression has been gained that a push toward not prescribing takes precedence over attention to alleviation of symptoms. When a prescription is granted, only a small number of tablets are given.
What is actually going on to produce these putative manifestations? My feeling is that primary care physicians are under the impression that their licence to practise is in jeopardy if they prescribe opioids, and that such acts place them under increased scrutiny from licensing authorities. This leads to a reluctance to prescribe opiates and to undue weight being placed on resisting requests for opioids, however appropriate such prescribing might be.
If my impression is correct with regard to opioid prescription, then physicians, licensing authorities, and regulatory bodies need to get together and move the pendulum back toward concern for appropriate patient care and away from the fear of retribution.
—Anthony Walter, BA, MB BCH
This letter was submitted in response to “Re: Evidence-based opioid sparing approaches to pain management.”
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