Is general practitioner involvement in the initiation of opioids for chronic non-cancer pain associated with opioid dose and concurrent drug use?

Abstract\nKEY POINTS<italic>Objective</italic> Is the involvement of the regular general practitioner (GP) in the decision to initiate opioid treatment for chronic non-cancer pain (CNCP) associated with two main risk factors for serious adverse events: increased opioid dose and the concomitant use of prescribed benzodiazepines or benzodiazepine-related medications? <italic>Design and setting</italic> An anonymous web-based survey was conducted in the county of Rogaland, Norway, during the spring of 2021. <italic>Subjects</italic> GPs who self-reported applying at least once for reimbursement of opioids prescribed to treat CNCP. They were asked to answer the survey based on the last patient for whom they recalled submitting a reimbursement application. <italic>Main outcome measures</italic> 1) Total opioid dose in daily oral morphine equivalents (OMEQ). 2) Concurrent use of benzodiazepines and/or benzodiazepine-related drugs. <italic>Results</italic> The daily opioid dose was lower when the surveyed GPs initiated the opioid treatment (36 OMEQ, <italic>n</italic> = 25), than when others had initiated the treatment (108 OMEQ, <italic>n</italic> = 31, <italic>p</italic> = 0.001). For concurrent use of benzodiazepine or benzodiazepine-related drugs, no significant difference was found (33%, <italic>n</italic> = 9 with GP involvement <italic>vs</italic>. 47%, <italic>n</italic> = 16, <italic>p</italic> = 0.279 with no GP involvement). <italic>Conclusions</italic> GP involvement in the initiation of opioid medication for CNCP was associated with a lower opioid dose being prescribed. <italic>Implications</italic> GP involvement in the initiation of opioid prescriptions may facilitate safer prescribing.Opioid treatment against chronic non-cancer pain (CNCP) can be reimbursed in Norway. High opioid doses and the concomitant use of other medications with addictive properties, particularly benzodiazepines, increase the risk of serious adverse events. When the general practitioner (GP) in the survey had initiated the opioid treatment, this was associated with a lower opioid dose, but not with less concomitant use of benzodiazepines. [ABSTRACT FROM AUTHOR]