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The prescription of opioids is a contentious issue for many general practitioners when in consultation with their patients. Current clinical practice of opioid prescription, particularly in rural areas, is at odds with clinical evidence. Overdoses from prescribed opioids are at record levels in Australia and pharmaceutical opioid deaths now significantly exceed heroin deaths.
JCU Academic GP Registrar, Dr Takeh Ichikawa, teaches clinical skills to JCU medicine students and is currently on rotation at a GP practice in the Far North Queensland community of Innisfail. He’s undertaking research to better understand opioid prescription from a GP registrar’s perspective to inform teaching for future registrars.
“Opioid prescription, especially for chronic non-cancer pain, is such a big issue in Australia, and right across the world,” Dr Ichikawa says. “The evidence suggests we should hardly ever use opioids for chronic non-cancer pain, and as GP registrars, we’re taught that you shouldn't be prescribing it. Then you go out and you see it so often in practice and it’s what the patient expects as well.
“It's a very tricky and uncomfortable situation to be in as a doctor. The patient says they’re in pain, and you want to help them. But you know that by helping them in the short run, you can actually be making the future worse for them.”
Seventy per cent of all fatal opioid overdoses in Australia involve prescription opioids. The Australian Government’s Department of Health has been monitoring opioid prescriptions by GPs. Statistical analysis conducted in 2018-2019 revealed the prescribing rate of opioids in regional, rural and remote areas was over 51 per cent higher than in metropolitan areas.
With a background in exercise science, Dr Ichikawa has a long-held interest in pain medicine. Motivated by what he was seeing in clinical practice, he decided to delve deeper and analyse the experiences of other JCU GP registrars in prescription practices. He commenced the JCU project funded by the Royal Australian College of General Practitioners (RACGP), earlier this year.
“Focusing the research on GPs makes sense to me as we are responsible for over half of all opioid prescriptions in Australia. So we’re the one’s doing the damage, you might say. My question is then, how can we be the ones to break the cycle?”
“My research is looking at how JCU GP registrars feel about the opioid prescription, sharing the difficulties and success stories they’ve had.
While the project is still in its infancy, Dr Ichikawa aims to inform training long-term to provide concrete supports so that opioid prescriptions are limited to only those clinical situations where evidence shows opioids to be of proven value.
“From a clinical practice point of view, it's clear cut that we should be avoiding or reducing opioid prescription. So this project is more about how we can improve patient communication, supervisor support, the resources available to GPs and the types of practice protocol that should be in place.
“I want to do this research so that the next generation of GPs will be better trained on opioid prescription and equipped to deal with these situations.”
For Dr Ichikawa, the JCU research project is a further demonstration of his passion for regional and rural health. Following his final rotation in Innisfail, he will undertake a Fellowship in Advanced Rural General Practice (FARGP). He knows that practising as a GP in Far North Queensland is where he wants to be.
“When a patient comes back and says ‘what you did for me has made a big difference in my life’, that’s the most rewarding part of it for me. I think the doctor-patient relationship should be a focus for GPs in general, but I think you see a lot more of it in regional and rural areas.”
Director of JCU GP Training, Associate Professor Lawrie McArthur, weighed in on the issue of opioid prescriptions by GPs and Takeh’s research project.
“This is an important topic for all doctors, and JCU GP Training ensures each registrar is well informed and trained in their professional reponsibility in areas such as opioid prescription. Takeh’s topic of academic research highlights the importance of research underpinning clinical practice,” Assoc Prof McArthur says.
Dr Ichikawa would like to talk to current JCU registrars about their prescription practice and experience. If you’re interested in getting involved, you can contact Dr Ichikawa directly at email@example.com