skip to main content

Prescription opioid dependence — RACGP Fellowship MCQ

Instant feedback + full explanation. One question, done properly.

HardMental healthPrescription opioid dependenceRACGP Fellowship

A 44‑year‑old woman receiving long‑term opioid therapy for non‑cancer chronic back pain presents requesting an early repeat prescription. She reports escalating opioid doses, daytime sedation and constipation; pain scores remain unchanged and her functional capacity has declined. What is the most appropriate next step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Review harms versus benefits, check controlled‑medicine history and plan a structured opioid taper with multimodal support

This patient demonstrates signs of opioid‑related harm (escalating dose, sedation, constipation), no functional benefit and likely prescription opioid dependence. Australian guidance (RACGP’s Prescribing Drugs of Dependence Part C2) advises reviewing treatment goals, assessing for aberrant behaviour, and planning structured opioid tapering when therapy is ineffective or harmful, rather than dose escalation, abrupt cessation, benzodiazepine addition, or prescriptive convenience. Shared decision‑making and integrating non‑opioid and psychosocial strategies optimize functional outcomes and safety, aligning with current Australian practice.

Reference: RACGP. Prescribing drugs of dependence in general practice, Part C2: The role of opioids in pain (2017); and Wong G. Pharmacological management of chronic non‑cancer pain in frail older people. Aust Prescr 2022.