How can GPs and pharmacists work to address the issue of opioid prescribing in Australia? asks Michael Wong
Australia is currently facing a significant opioid epidemic, with a staggering amount of GPs (4,800) under significant pressure to prescribing opioids for pain management without adequate support from other medical specialists.
Strong pain medication is not always the solution, particularly when treating chronic pain.
One in five Australians live with ongoing chronic pain and as the population ages, the prevalence of pain is expected to increase, according to the Consumers Health Forum.
Recent general practice data shows that opioids were prescribed in 73% of cases where patients complained of general multi-site pain. Between 1992 and 2012, opioid dispensing by doctors increased 15 fold, according to Pain Australia.
70% of all fatal opioid overdoses in Australia are from prescription opioids and now pharmaceutical opioid deaths have surpassed heroin deaths by a huge margin, according to the Chief Medical Officer.
The past couple of years has also seen a dramatic shift in people taking stronger prescription opioids such as fentanyl and endone in place of morphine. However this use of stronger opioids is increasing the amount of harm associated with drugs rather than decreasing it.
It is still a “bandaid” solution to chronic pain i.e. a solution that does not address the cause of the problem.
Opioids can lead to Australians heavily relying on medication to provide temporary pain relief as well as side effects such as nausea, constipation, difficulty breathing and dizziness. To put it simply, people are unaware that that they can access affordable, effective options to manage their chronic pain without having to take opioids.
It is essential for GPs to find out what the cause of their patient’s chronic pain is before even considering to prescribe pain medication. Use of non-opioid pain relief medications, physiotherapy, Cognitive Behavioural Therapy (CBT), acupuncture, massages and relaxation techniques are methods that GPs should look into and offer patients on a case-by-case basis in conjunction with a multidisciplinary pain clinic, where possible. In some cases, surgery may be the most effective solution, depending on the severity of the patient’s chronic pain.
Just changing and regulating the supply of opioids does not address the problem or demand encountered by many Australians. There is a lot GPs can do to help patients in education of chronic pain and working in partnership with other medical specialists in multidisciplinary chronic pain clinics to explore “non-opioid” treatment options.
Due to the increasing health demand of growing population, the current health system is somewhat overwhelmed to the point that prescriptions and over-the-counter solutions are quicker “fix” then, to access pain education and multi-disciplinary care.
Pharmacists are involved in the prescriptions and over-the counter solutions stage, and therefore, has a great opportunity to intervene current management. For example, if a GP keeps prescribing anti-inflammatory for a few months for a patient, the pharmacist can then ask the patient why patient is on medication; intervene and educate them and investigate the diagnosis of pain.
Pharmacists can change the course of the presentation and help patients to be better informed about their health situation. This leads to better pain management.
As we are using more adjunctive/synergistic pain medications (like benzodiazepines, anti-convulsants and muscle relaxants), Pain Management Specialists and General Practitioners need to work more closely in partnership with pharmacists to ensure patient safety and to reduce risk of side effects from polypharmacy. Patient education by pharmacists further enhances patients’ understanding and help to reduce risk of problems associated with poly pharmacy.
A better communication between doctors and pharmacists will also assist in preventing inappropriate and misuse of opioids, especially when patients go to multiple GP practices.
Dr Michael Wong is an experienced neurosurgeon and spinal surgeon who specialises in chronic pain management.