Chronic Pain FAQs

“I’ve run out of meds” – Why have they run out so early - Is this an indication of overuse or abuse? Screen for symptoms of dependence*/withdrawal.

Dependence syndrome: “A cluster of behavioural, cognitive, and physiological phenomena that develop after repeated substance use and that typically include:

a strong desire to take the drug / difficulties in controlling its use /persisting in its use despite harmful consequences / a higher priority given to drug use than to other activities and obligations / increased tolerance /and sometimes a physical withdrawal state”.1

“I’ve lost my script / someone stole my meds” – Is this drug seeking behaviour2 ?

For a person suspected of drug dependence, it is illegal to prescribe drugs of addiction without written authority from the NSW Ministry of Health.

Immediate clinical advice is available via local Drug and Alcohol services or through the 24 hour NSW Drug and Alcohol Specialist Advisory Service (DASAS) on telephone 1800 023687 (regional/rural) or (02) 9361 8006 (Sydney Metro).

The general public can call the 24 hour Alcohol and Drug information Service 1800 422 599 (regional/rural) (02) 9361 8000 (Sydney Metro) or the Opioid Treatment Line (office hours) 1800 642428

“My regular doctor is away / I’m new in town and a GP won’t prescribe what I normally take” – The need to screen for drug dependence and drug seeking apply. In this scenario it is often challenging to confirm the details and coordinate a treatment plan out of hours.

The ED is not the place to prescribe regular medications, but strictly time limited analgesia may be provided for treatment of a patient in pain, until they can see a local doctor the next possible morning to devise a sensible treatment plan.

This may require daily visits to a GP practice for short term prescribing until the medical and prescribing history can be clarified.

Further References and Resources

[1] International Classification of Diseases 10th RevisionWorld Health Organization. 2010. http://apps.who.int/classifications/icd10/browse/2010/en

[2] Recognising and managing drug dependent persons: Notes for medical practitioners TG116A/15 NSW Health 2015 .

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