Every general practitioner has patients with chronic nonmalignant pain issues. At some point the possibility of using prescribed opioids is raised. General practitioners need to make the decision to initiate opioids cautiously, as a significant number of patients will gain little long term relief from these drugs, and some will exhibit problems resulting from dependence to the prescribed drug. For these reasons, patients and the prescriber should agree to a drug trial before agreement is reached to prescribe for the long term. All prescribing needs to be under strict control, with patients picking up medication from a pharmacy relatively frequently. If the GP feels they have lost control of the situation, urgent advice from a specialist in pain or drug and alcohol medicine should be sought.
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