Document 6469007

Produced by the
NHS Rotherham
Medicines Management
Team
Tel (01709) 302639 if further
information is required.
The trouble with
Tramadol
The national statistics office has released the 2012
report on deaths related to drug poisoning in
England and Wales.
Some of the key findings are;
There were 1,706 male drug poisoning deaths
(involving both legal and illegal drugs)
registered in 2012, a 4% decrease since 2011.
Female drug poisoning deaths have increased
every year since 2009, reaching 891 in 2012.
The number of male drug misuse deaths
(involving illegal drugs) decreased by 9% from
1,192 in 2011 to 1,086 in 2012; female deaths
decreased by 1% from 413 in 2011 to 410 in
2012.
The key finding of most relevance to Rotherham is
The number of deaths involving tramadol
have continued to rise, with 175 deaths in
2012 – more than double the number seen
in 2008 (83 deaths).
Tramadol
A notable trend that has emerged in recent years is
the steady increase in the number of deaths
mentioning tramadol .The first recorded death was in
1996, and deaths have risen to an all-time high of
175 deaths in 2012. This increase in deaths may be
partly explained by a 35% increase in tramadol
prescriptions over the last five years
In addition, the latest ‘Street Drug Trends Survey’
Clinical Commissioning
Group
carried out among police forces, drug
agencies, frontline treatment services and drug user
groups highlighted the continued rise in the
recreational use of tramadol and other synthetic
opioids. Unlike most other opioid analgesics,
tramadol is not a controlled drug.
Tramadol Prescribring
Items/ASTROPU
1.4
1.2
1
0.8
0.6
0.4
0.2
0
Rotherham
England
Rotherham has consistently had a prescribing rate
for tramadol above the national average and there
is considerable practice variation (see below)
Action
Commence no new patients on tramadol
The CCG has requested RFT remove
tramadol from the hospital formulary
Do not routinely continue tramadol if the
patient is discharged on it. Instead across
to to co-codamol or down to paracetamol
(RFT surgeons insist that they use it for
post operative pain only and it should not
be continued)
Be cautious if patients request the drug by
name
Tramadol Items\ASTROPU 12 months to July 2013 Practices vs National Average 12
months to July 2013
45
40
35
30
25
20
15
10
5
0
Sharing good practice
Reducing Hypnotic prescribing
The thought of getting patients off long term hypnotics and anxiolytics has always filled Medicine Management
Teams and prescribers with apprehension. We all know the rational and the benefits, but we also know the
difficulty of convincing patients of these, when the withdrawal side-effects of insomnia and anxiety just
reinforce to the patient that they need this medication.
However, Treeton Medical Centre was up for the challenge. After years of trying gentle strategies and only
making minor changes, they focused their full attention and confronted the problem head-on. A year later, the
results are fully visible in the prescribing data, and the practices prescribing rate is moving towards the CCG
average.
350
Total ADQ per ASTROPU for hypnotics & Anxiolytics
300
250
1st Quarter 2012/2013
200
1st Quarter 2013/2014
150
100
VILLAGE
THORPE HESLEY
HIGH STREET
BROOM VALLEY ROAD
WICKERSLEY
KIVETON PARK
MARKET SURGERY
CROWN STREET
BROOM LANE
SHAKESPEARE ROAD
SHRIVASTAVA'S
DINNINGTON
MORTHEN ROAD
CLIFTON
RAWMARSH
STAG
KILNHURST
GREENSIDE
ST ANN'S
PARKGATE
BRINSWORTH
SWALLOWNEST
GREASBROUGH
WOODSTOCK BOWER
THRYBERGH
SURGERY OF LIGHT
DALTON
MANOR FIELD
CANKLOW ROAD
TREETON
YORK ROAD
ROSEHILL
THE GATE
BLYTH ROAD
0
QUEEN'S
50
How was this done?
No easy answers unfortunately, but this is the strategy that Treeton used.
Searches run to ascertain patients on hypnotics
All staff were made aware of the need to reduce hypnotics
All hypnotic repeat prescriptions were changed to acute
When Patients requested medication they were given two weeks supply and an appointment made to
see the GP for a review
Clinicians discussed the use of hypnotics with patients
Clinicians introduced a gradual reduction of the hypnotics where appropriate
All hypnotics to remain on acute prescription unless the clinician had specifically indicated otherwise
If patients needed a course of hypnotic medication, they were informed it was ONLY for short term use
and given less than 2 weeks supply
If a patient requested another supply then an appointment for a review by a clinician was made
Patient’s took a while to get used to the new system, and patients that DNA’d appointments or came up with
excuses why they couldn’t attend for a review had the prescriptions reduced to weekly until a review had been
undertaken. There was also resistance to the medication being stepped down or stopped. However,
clinicians were prepared with the knowledge of the side-effects such as increased risk of falls and car-crashes
etc.
Could you do this too?
There is a prescribing KPI measuring the percentage of patients aged over 55 years prescribed a benzodiazepine.
Also, for 13/14 we have a PBC LIS target to reduce the use of Z-drugs to below the national average.
Please contact the Medicine Management Team if you would like support for this or any other prescribing area.