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Poppy love

BMJ 2008; 337 doi: (Published 31 October 2008) Cite this as: BMJ 2008;337:a2334
  1. Janet Gillespie, salaried general practitioner, Buntingford Medical Centre, Buntingford, Hertfordshire

    I spread out the crumpled note the patient had given me while he spoke: he had been to the pain clinic “for his back,” and they had recommended this to help his pain. If he took the note to his (implied) trusty GP, he or she would sort it out for him; and if the treatment was unsuccessful, the pain clinic suggested, he could be referred to a neurosurgeon for assessment. Mercifully, the trade name was scrawled in block capitals. The British National Formulary revealed it to be a methadone transdermal patch.

    I sat back and considered the matter. It was not an entirely unreasonable suggestion: the patient was already taking paracetamol, tramadol, and amitriptyline, with only moderate control, and his sleep was still disturbed. What surprised me was that the opiate prescription had come before a referral for a surgical opinion.

    In the mid-1980s, when I trained as a general practitioner, opiate patches were only the proverbial twinkle in a pharmacologist’s eye, and use in the community of “Brompton cocktail” was considered avant-garde. Ten years …

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