More hospitalisations are caused by side effects of intended use of licit opioids, than from illicit use or misuse
Harms highlighted in a new report underline the pressing need for national real-time monitoring, says the Guild’s Anthony Tassone.
A new report, Opioid harm in Australia and comparisons between Australia and Canada, from the Australian Institute of Health and Welfare has shown that in 2016-7, 15.4 million opioid prescriptions were dispensed under the PBS to 3.1 million people.
Of these, strong opioids including morphine, oxycodone and fentanyl accounted for 59% of scripts, with oxycodone the most commonly dispensed opioid script (37% of all opioid prescriptions dispensed).
Deaths involving opioids have nearly doubled in a decade, from 591 to 1,119, but remain lower than the 1999 peak of 1,245.
An estimated 735,000 people were using opioids for illicit or non-medical purposes, including approximately 715,000 using pharmaceutical opioids and 39,700 using heroin.
The rate of hospitalisations due to side-effects of pharmaceutical opioid use per 100,000 population almost doubled in the 10 years to 2016-7, after adjusting for age.
In 2016–17, there were 27,435 hospitalisations—or 75 per day—where a side effect of pharmaceutical opioid use was indicated.
Between 2006 and 2016, there was also a 25% rise in the rate of hospitalisations where opioid poisoning was recorded as the main reason for admission.
“In the case of both deaths and hospitalisations, pharmaceutical opioids were more likely to be responsible than illegal opioids,’ said AIHW spokesperson Dr Lynelle Moon.
The report points out that all data are missing for low-dose codeine then available over the counter, as well as opioids on private scripts.
After adjusting for differences in the age structure of the population between 2012–13 and 2016–17, the rate of prescriptions dispensed rose by 9%, from 53,683 to 58,278 per 100,000 population.
While there was a 30% increase in the age-standardised rate of prescriptions dispensed for oxycodone, there were decreases in the rate for several other opioids. This included an 11% decrease for codeine, a 19% decrease for fentanyl, a 13% decrease for methadone and a 19% decrease for morphine.
In 2016, of people who had recently used painkillers/analgesics and pharmaceutical opioids for non-medical purposes, about half (52%) usually obtained them by purchasing over-the-counter pharmaceutical drugs at a pharmacy and about one in five obtained them with a medical prescription or by doctor-shopping.
“Looking across Australia and Canada, we see some similarities in the harm caused by opioids. In both countries, there were more hospitalisations involving side effects from intended use of pharmaceutical opioids than from misuse or use of illicit opioids,” Dr Moon said.
However, the data shows some differences in the type of opioids used. For example, while the rate of prescriptions for fentanyl were similar in both countries, evidence suggests that illicit use of fentanyl is more common in Canada, while heroin use is comparatively higher in Australia.
“Different patterns of opioid use have different impacts on users and the health system. For example, fentanyl is more potent than heroin and is more likely to be lethal, meaning there is a higher risk of death before they can receive health care services,” Dr Moon said.
The two countries were compared due to their similar demographics and similar health care systems, including government-funded pharmaceuticals.]
Pharmacy Guild Victorian branch president Anthony Tassone told the AJP that the harms highlighted in the report, particularly deaths from prescription opioids, further confirms the “urgent and critical need for the implementation of a comprehensive real time prescription monitoring system in every state and territory across Australia”.
“With every passing month that there is not a real time prescription monitoring system, doctors and pharmacists are left without an essential and potentially life-saving clinical decision making tool that better informs decisions around prescribing and supplying medicines,” he said.
“Already the early experience with the rollout of SafeScript real time prescription monitoring in Victoria has been largely positive with both doctors and pharmacists finding the information extremely useful to help provide better care for their patients and reduce harm.
“It is providing more opportunities for pharmacists and doctors to collaborate in helping support patients potentially serious health concerns.
“However, as good a tool as real time prescription monitoring can only be, it’s vital that there are sufficient resourcing of treatment and support programs to help address drug dependency issues once identified.
“It’s one thing to identify the problem, but another to treat and support the condition.”
Painaustralia CEO Carol Bennett said the report shows that Australia is facing a “pain epidemic”.
“These findings are not just about medication, but shine a light on Australians fighting what it often an invisible illness – pain,” Ms Bennett said.
“Pain is the major reason people go to the doctor, and it is the main reason opioids are prescribed. It is one of the leading causes of disability, absenteeism and forced early retirement in Australia.
“We know opioids can be a useful medication for managing short-term, acute pain. The problem is they’re often treated as the first and only line of defence for managing all pain conditions, including chronic pain.
“In the long run, opioid use leads to rising tolerance and dependence, as well as actually making the body more sensitive to pain. Accidental overdose, hospitalisations and death are often the result. Clearly something needs to change.”
Read the full report here.