Optimise – Service Evaluation of an Innovative Service to Reduce Prescription Medication Dependence

AIMS: Opioids, gabapentinoids, benzodiazepines and z-drugs cause dependence, increase deaths, and have been found to be ineffective for long-term conditions. Despite the risks, these are some of the most prescribed medications. In response, we worked with commissioners to develop an innovative service ‘Optimise’ for the treatment of prescription medication dependence. Optimise aimed to support patients to reduce and stop prescribed medications that can cause dependence when the medications were not clinically recommended. METHODS: Optimise started in February 2020 in the North of United Kingdom. The service was staffed by two addiction nurses, with support from the Addictions Consultant Psychiatrist and team leaders. GP's identified suitable patients, gained consent to refer and referred to Optimise. Patients received a harm information and service letter, after which they were offered telephone triage, assessment, and ongoing psycho-social support. The nurses worked closely with GP's and advised on prescribed medication reduction plans. Due to COVID-19, most patients had telephone appointments. Humber Teaching NHS FT service evaluation approval. All referrals were reviewed retrospectively to assess demographics and outcomes. Friends and family (FFT) test offered to patients. Data were analysed via excel. RESULTS: Twenty-one GPs referred 258 patients (Feb 20-Oct 22). Most were female (70%) and all white; mean age 56 (21-97) years. Patients were prescribed opioids (92%), gabapentinoids (32%), benzodiazepines (9%), and/or zopiclone (7%). The most common opioid prescribed was morphine, followed by oxycodone and fentanyl. A letter was sent to 254 patients referred, 217 patients attended telephone triage, with 148 agreed to work with Optimise. Of 145 (56% of referred patients) who attended the assessment, 86% gradually stopped (n=24; 17%) or reduced (n=100;69%) their prescribed medications. Patient feedback: Eighteen patients completed FFT and stated the service was good or very good. ‘The nurse was informative and has helped me reduce my medications when I thought I wouldn't be able to.’ ‘Listened to my concerns and gave me time before changing my medication.’ CONCLUSION: Optimise is an innovative service that has helped patients of all ages to reduce and stop prescribed opioids, benzodiazepines, gabapentinoids and zopiclone, that can cause dependence, increase overdose risks, and were not clinically recommended. These patients had previously not been able to reduce or stop these medications. It is positive that with two nurses there has been such a great impact with excellent outcomes and good patient engagement. Commissioners should look at funding similar services to enhance the support for patients who are prescribed medications that can cause dependence.