Rob Poole has had an interest in rational prescribing and an interest in substance use for many years. Over the past ten years, in the context of CFMHAS, expertise in the two areas have come together in a major programme of clinical innovation and research into the use of high dose opioid drugs in the treatment of chronic pain. Rob Poole has worked closely with the Pain Management Team at Wrexham Maelor Hospital, and particularly with Lucy Jones, Clinical Nurse Specialist in Pain Management, to develop effective responses for patients who experience severe side effects and little pain relief on treatment with high dose opioids. They have developed an intervention that is predominately psychosocial, with some novel approaches to de-prescribing. Many patients find tapering opioids extremely difficult. For carefully selected and consenting patients they have developed a programme of out patient rapid dose reduction, which often involves replacement with fixed regime low dose methadone (prescribed as an analgesic, not as a drug dependency harm reduction strategy).
Although there has been some significant institutional and professional resistance to this work, it continues and we are evaluating the intervention. We also have a group of clinical staff and researchers working on a series of related projects, examining community prevalence, patterns of high dose prescribed opioid use, cognitive effects of high dose opioids, patient and carer experience of high dose opioid use and evaluation of a programme of psychoactive medicines management in a prison setting. We are also developing work with prescribers, including an intervention to help GPs to avoid prescribing high dose opioids. Much of this work is led by John Bailey.