The use of prescription opioids in the United States is routinely described as a “public health crisis” and an “epidemic” and new figures reveal Australia is in danger of heading down the same path.
A paper published in the British Journal of Clinical Pharmacology, analysing the dispensing of opioids through Australia’s Pharmaceutical Benefits Scheme from 2013 to 2017, reveals opioid-related deaths have doubled in the past 10 years in this country.
Research by Centre for Medicine Use and Safety (CMUS) PhD candidate, Samanta Lalic, found that overdose from prescription medicine had already overtaken road deaths and illicit drugs overdoses as cause of death in Australia.
“Opioids do have an important role in managing cancer pain and acute non-cancer pain,” Ms Lalic said.
“However their use remains less well established for chronic, i.e., long-term, non-cancer pain.
“For the treatment of chronic pain, we need to change prescribing culture and raise the level of awareness of other treatment options among patients.
“The goal of care, treatment expectations and intended duration should be agreed upon by patients and prescribers prior to opioid initiation.
“In many cases, the safest and most effective way to treat chronic pain will involve a combination of therapies, including exercise, physiotherapist and non-opioid painkillers.”
Society of Hospital Pharmacists of Australia (SHPA) chief executive, Kristin Michaels, said opioid prescription to manage acute pain following surgery was a key trigger for potential misuse.
“There’s a growing body of international evidence that shows the rise in opioid related harm in comparable healthcare systems and the need for urgent action,” she said.
“This growth has been driven by a range of factors, including unrealistic expectations of pain management, over-prescribing and lack of evidence-based educational programs for health professionals.
“Feeding into this environment, it is increasingly recognised that opioid use after treatment in hospital is an important factor, and therefore hospital pharmacists and their healthcare colleagues can play a key role in mitigating the risk of future opioid misuse and dependence,” she said.
Ms Lalic’s research not only reveals just how many Australians are being dispensed opioids, it also finds that 2.6 per cent of them – or around 50,000 people – become long-term users over a year.
An increasing number of patients were being started on stronger opioids, which Ms Lalic said was the real cause for concern, as both long-term use, and the use of strong opioids were associated a range of “adverse health outcomes”.
“In addition to overdose deaths, high-dose opioid use has been associated with falls, fractures, hospitalisations and motor vehicle accidents,” she said.
Ms Lalic said the next step was to determine how prescribers and patients escalated doses over time.
“This is important because international research has demonstrated a strong link between prescribed dose and overdose deaths,” she said.
Last year, Australia’s Therapeutic Goods Administration called for consumers and health professionals to provide input into strategies to address high rates of opioid prescribing.
Ms Michaels also cited data from an Australian Institute of Health and Welfare (AIHW) report, in collaboration with the Canadian Institute for Health Information (CIHI), titled Opioid Harm in Australia and Comparisons between Australia and Canada.
“In 2016-2017 there were 4,232 emergency department presentations – or 11.6 per day – for opioid poisoning and 9,636 hospitalisations – or 26 per day – with opioid poisoning as any diagnosis,” Ms Michaels said.
“As medicines experts working in multidisciplinary medical teams, that treat people who are the most acutely sick or experiencing the most severe pain, SHPA members understand the reality behind these alarming figures and we will continue to work to influence policy change – both with them and on their behalf.”
Ms Michaels said the data in the report cannot be ignored.
“With more than 2.2 million surgeries undertaken in 2016 – 2017, the area of post-operative care is a key target for reducing risks of premature mortality and long-term harm related to opioid misuse among Australians of all ages,” she said.
“In July this year, key stakeholders from across Australian healthcare explored a diverse range of opioid harm reduction strategies at the inaugural ‘Medicines Leadership Forum’, informed by data from 135 public and private hospitals gathered by SHPA members.
“SHPA continues to work with our members to understand their experiences and the role of hospital pharmacies in this important area of patient care and we look forward to working with clinical partners in this multidisciplinary area to improve long-term patient outcomes.”
The SHPA will be releasing the Reducing opioid-related harm: An Australian hospital landscape paper in the coming months.