Shaping and delivering services in primary care: benzodiazepine and opiate withdrawal service
Dependency on benzodiazepine and opiates is an increasing problem. Jeff Fernandez uses case studies to show how a nurse-led addiction service based in primary care can improve patient outcomes
This article looks at the development of the benzodiazepine and opiate withdrawal service (BOWS) based in addiction services in London. The service was created to implement a manageable and sustainable model that would treat patients with benzodiazepine and codeine-based dependencies. It was envisaged the service would effectively treat patients in GP practices in two boroughs in London. The article outlines what is possible in terms of treatment for patients with issues of opioid dependency, by examining two in-depth case studies. It also illustrates what is possible for nurses in the modern NHS and can be used as a resource to shape and deliver services with positive patient outcomes. Nurses should be seen as shaping and delivering care in the NHS. This is a role that should be promoted to a greater degree, wherever possible.
Evidence collected by Public Health England (PHE) shows an increase in the use of over-the-counter codeine medicines (PHE, 2014a). It is also increasingly recognised by health professionals, that opioid medications used to treat pain become less effective over time. Doses can be increased to high levels and this usually does not work and can create a dependency on opioid medication in the long run, particularly codeine-based medications (PHE, 2014a; 2019; British Pain Society, 2020).
In the US, the prescribing and the illicit drugs trade in opioid painkillers has led to an increase in mortality figures (National Institute on Drug Abuse, 2021). The government has called the situation at present a national crisis as 130 people die every day from opioid-related drug overdoses. In the UK there is evidence that opioid analgesic prescribing has increased in the last decade, with a doubling of mortality figures (Office for National Statistics, 2019).
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