Almost two million Australians begin taking prescription opioids every year, with thousands becoming long-term users.
Data from the Australian Institute of Health and Welfare has revealed deaths involving opioids have nearly doubled in the past 10 years in this country, with pharmaceutical drugs accounting for more drug-related deaths in Australia than any other drug category.
Professor John Saunders is a consultant physician in internal medicine and addiction medicine, with a career spanning 35 years as a clinician, researcher, service director and academic.
Speaking in Brisbane earlier this week, Professor Saunders, Director of the Drug and Alcohol program at Wesley Hospital said addiction to drugs like codeine, morphine and oxycodone – commonly marketed as OxyContin – was a growing problem in Australia.
“In the space of just 15 years, we’ve seen this become a mini epidemic,” he said.
“Many patients find themselves initially prescribed opioids for chronic pain, then they take more and more to feel better and they find they like the effect – then they’re stuck in that pattern.
“They require more for the desired effect of treating their pain, they build up a tolerance and it’s a never ending circle.”
Professor Saunders believes it is time for the medical profession – General Practitioners (GPs), hospitals and the pharmaceutical industry – to take responsibility for the growing level of opioid addiction.
“You know, 30 years ago, there was a view in the medical profession that opioids were treated with great respect – they were a powerful drug in terms of scheduling,” he said.
“Then there was a view that people with chronic pain were being under-treated and there was a move to liberalise the prescription of opioids. And of course, this was supported by the pharmaceutical industry.
“And over time, GPs became more liberal in their prescribing but didn’t realise the side effects as much as they should.”
The Society of Hospital Pharmacists of Australia (SHPA) recently released a study titled, Reducing opioid related harm – a hospital pharmacy landscape paper which exposed national inconsistencies in pharmacy services aimed at reducing the risk of opioid misuse, as well as the extremely high use of sustained release opioids.
SHPA president, Professor Michael Dooley, said the study had put a spotlight on the link between the prescribing and supply of opioids to patients after surgery, in both public and private hospitals.
“We found clinical pharmacy services are often unable to prioritise surgical patients being discharged and these patients are not having an appropriate review of their medication,” he said.
“Consequently, as identified in this report, more than 70 percent of hospitals frequently supplied opioids for patients to take home ‘just in case’ even when they have not required them in the 48 hours prior to discharge.
“Also of significant concern, pharmacists reported extremely high use of sustained-release opioids in the treatment of acute pain for opioid-naïve surgical patients.”
Professor Dooley said despite a promising start, implementation of opioid stewardship programs was insufficient and disparate across Australia.
“Our findings reveal less than five percent of hospitals have formal opioid stewardship programs, which are showing good progress in reducing unnecessary opioid supply and even fewer have invested in other innovative responses to address this growing problem,” he said.
“But we feel that by beginning an important conversation about services in hospitals, the SHPA seeks to collaborate with other healthcare practitioners and organisations to prevent unnecessary harm caused by opioids initiated in the hospital setting.”
Professor Saunders added that in recent years, the medical profession had come to understand the opioid crisis and their role in it.
“At the moment, there is a greater understanding of the potential for side-effects and addiction,” he said.
“The evidence of complications is there, and it’s right and proper that we take a step back.”
And he said there was hope for the thousands of patients who found themselves addicted to painkillers.
“There is a prospect other medications such as anti-inflammatory drugs, paracetamol and anaesthetic injections, can help people manage their pain,” Professor Saunders said.
“Some people have been able to reduce their dependence on opioids and manage their pain without the use of drugs – it can take a long time, two to three years, and that does require quite a significant commitment on the patient’s behalf.
“Methadone is another alternative, and it’s a valuable treatment, but there is a stigma associated with it – it’s associated with heroin addiction and in the view of people addicted to prescription medication, it’s associated with people who are ‘not like them’.
“It’s an important message, there is hope and it’s quite possible to not be reliant on these drugs and to be pain free. In fact, very often, when opioid use is reduced, the patient finds the pain is not as bad as they thought.”
Professor Dooley said the judicious use of opioids was important in the treatment of pain and recovery from surgery.
“In 2016-17, there were more than 2.2 million surgeries in public and private hospitals following which, the prescribing and supply of opioids is commonplace,” he said.
“Currently, provision of opioid de-escalation plans at hospital discharge are rare, with less than 10 per cent of respondents providing these.
“Hospital pharmacists have a role to play in supporting patients to use medicines when needed and to reduce their risk of harm through involvement in discharge planning, and the provision of cognitive clinical services for patients at the bedside,” Professor Dooley said.