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People with chronic pain that can’t be explained by other conditions should not be prescribed opioids because they do more harm than good, the medicines watchdog has warned. The National Institute for Health and Care Excellence (NICE) has said people should instead be offered group exercise, acupuncture and psychological therapy. In new draft guidance, NICE said most of the common medications used for chronic primary pain has little or no evidence to support their use in patients aged over 16. Its latest guidance comes amid concerns over the level of opioid use. In September last year a review by Public Health England found 1 in 4 adults have been prescribed addictive medications with half of them taking the drugs for longer than 12 months. NICE’s new draft guidance said some antidepressants should be considered for people with chronic primary pain but it said paracetamol, non-steroidal anti-inflammatory drugs such as aspirin and ibuprofen, as well as benzodiazepines or opioids should not be given because of concerns they might do more harm than good. Read full story Source: The Independent, 4 August 2020

Ambulance services have been urged to look at how suspected overdose and poisoning cases are prioritised after paramedics took 45 minutes to reach a woman with known mental health problems. Helen Sheath, 33, had been discharged from a mental health unit in early July last year and was still waiting for an outpatient appointment with a psychological assessment and treatment service when she took a fatal dose of sodium nitrate on 20 August. Her father called an ambulance at 6.20pm when she had locked herself in a bathroom and was threatening to take the sodium nitrate. But Bedfordshire and Luton senior coroner Emma Whitting said her father could not tell whether or not she had taken it, and that in view of her history of suicidal ideation, the call should have been treated as a category two – with an 18 minutes response target – rather than a category three incident. The first ambulance which was sent to her was diverted on route and it was only after a second call to the East of England Ambulance Service at 6.48pm, that the call was upgraded to category two – when the call handler selected a different set of questions, after being told she had ingested the chemical. A rapid response vehicle arrived at 7.05pm and the mental health street triage team attended six minutes later. Shortly afterwards she became acutely unwell and was taken to Bedford Hospital, where she received treatment but died shortly afterwards. In a prevention of future deaths report Ms Whitting said: “If the first call had been coded as a category two, it seems likely that the rapid response vehicle, mental health street triage team (and even possibly the double staffed ambulance) would have arrived on scene much earlier (potentially just before or just after Helen had ingested the sodium nitrate) which could potentially have altered the outcome.” The case comes just months after two other ambulance trusts were criticised in cases involving suspected or threatened overdoses. The prevention of future deaths report was sent to the Association of Ambulance Chief Executives and the emergency call prioritisation advisory group, which is run by NHS England. Neither would comment other than saying they would respond to the coroner. Read full story Source: HSJ, 15 June 2020

Problems with dispensing drugs during the COVID-19 crisis may be contributing to an “apparent increase” in deaths of patients receiving treatment for opiate addiction, the Care Quality Commission (CQC) has said. The regulator has said the increase in deaths “may be a result of some services stopping all daily dispensing of opiates” and has taken enforcement action against a “large national provider of substance misuse services” which ”stopped all daily dispensing”. The provider has not been named by the CQC as it is “entitled to an appeal period,” but the regulator told HSJ the provider had not recorded their risk assessments for their clients in relation to changes in drug dispensing. The CQC said the provider had now “assured us” individualised risk assessments were in place. The CQC is now reviewing all deaths of people which have been reported by substance misuse services since 1 March due to concerns about the apparent increase and “that some of these deaths may be related to changes in prescribing practices in response to COVID-19”. Read full story Source: HSJ, 27 May 2020