In hospitals Endone has become the new Panadol and Australia is going down the same path as the United States when it comes to opioids, say doctors.
The doctors were responding to a new study published today in the Medical Journal of Australia, which examined the state of opioid use in Australia.
Australia continues to experience rising rates of opioid prescription, write the authors: between 1992 and 2012, Australian opioid dispensing episodes increased from 0.5 million prescriptions to 7.5 million, with no evidence to suggest that these figures are reaching a plateau.
There has also been an increase in the number of opioid preparations available, with morphine, fentanyl and oxycodone the three largest groups.
“The overall increase in opioids in Australia likely reflects a population that continues to grow rapidly in part because of increasing life expectancy with chronic illnesses of ageing often associated with pain, previous under-prescribing, increasing incidence and survival from cancer, increased numbers of preparations available, poor access to allied health for non-pharmacological interventions, poor undergraduate and postgraduate education about opioid prescribing, aggressive marketing and the imperative for health professionals to better manage pain,” the authors write.
They examined short and long term harms of opioid use, listing longer-term harms including constipation, sedation, dizziness, loss of bone mineral density, hypogonadism and psychological impacts.
“People who use opioids long term for chronic non-cancer pain are at greater risk of misusing them, including through psychological dependency and overdose,” they write.
“These problems are prevalent in this cohort, with rates of misuse (21–29%) and addiction (8–12%) a cause for grave concern.”
Dr Evan Ackermann, GP and chair of the Royal Australian College of General Practitioners Expert Committee — Quality Care told MJA InSight that opioid prescribing in the acute setting needs to be examined, as the drugs are being prescribed when there are alternatives.
“Patients are also given a box instead of two to three pills. In hospitals, Endone has become the new Panadol so there is a cultural shift that we need to address.
“There has to be better discipline”, he told MJA InSight.
Dr Scott Masters, chair of the RACGP Musculoskeletal Medicine Special Interest Group and senior lecturer at the University of Queensland, told MJA InSight that concerns exist that Australia is “heading in the same direction as the US and that our rates are going up”.
He says some chronic pain sufferers see them as a quick solution and that people tend to stay on them once they have been prescribed.
The study authors examine what can be done to reduce inappropriate prescribing, including supporting GPs to manage patients’ chronic non-cancer pain in accordance with recommended guidelines.
“Evidence-based guidelines provide GPs with an evidence-based framework for the collaborative development of a treatment plan with the patient,” they write.
“There are also opportunities to strengthen safe opioid prescribing by GPs for non-malignant pain through specific education programs.
“Combining clinician education with an opioid dose limitation practice policy and implementing a practice policy of not providing repeat opioid prescriptions or authorising a dose increase without a formal medical review may reduce the risk of inappropriate dose escalation.
“High level evidence supports the use of methadone or buprenorphine in patients with chronic non-cancer pain who are addicted to opioids (high level evidence).”