Opioid quantities studied

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How many people were prescribed 10‐ or 20‐tablet pack sizes prior to PBAC-recommended changes?

Research led by the Pharmacy Department at the Princess Alexandra Hospital in Brisbane has reviewed oxycodone 5 mg immediate release (IR) tablet quantity prescribing on discharge prior to pack size changes.

These changes included reduced pack sizes of oxycodone 5 mg immediate release (IR) tablets from 20 tablets per box to 10 tablets, as recommended by the PBAC. In September 2019, Queensland Health adopted the restriction of a 10‐tablet maximum to be supplied on discharge.

Researchers conducted a retrospective audit in July 2019 on a randomised cohort of every fifth patient discharged with a prescription for oxycodone 5 mg IR tablets at the hospital. They audited 141 patients, or 19% of 730 eligible patients. Seventy‐one patients (50%) received 10 tablets on discharge, and 51 (36%) received 20 tablets.

Patients were prescribed a mean quantity of 13.1 oxycodone 5 mg IR tablets, they found. The lowest quantity prescribed was three tablets, and the largest was 20 tablets, according to results published in the Journal of Pharmacy Practice and Research.

There was no statistically significant difference in the average quantity of oxycodone 5 mg IR tablets given to naïve and non‐naïve patients, nor was there for other patient sub-categories such as age, indication, or length of stay in hospital.

Half of the patients audited (n = 67, 48%) had their medications dispensed at the hospital before discharge, receiving a mean quantity of 12.9 tablets. The remaining 74 (52%) patients received prescriptions for community pharmacy supply, equating to a mean prescribed quantity of 13.3 tablets.

Local hospital guidelines recommend that discharge pain relief medications should be limited to a duration of 3–5 days to reduce excess quantities of opioids being prescribed, the researchers said.

However, 122 of 144 prescriptions during the study period were for the available 10‐ or 20‐tablet pack sizes, as opposed to quantities built on estimating number of days’ supply for a patient based on their dose.

This “indicates that overall prescribing of IR oxycodone 5 mg tablet quantity is likely greatly influenced by pack size rather than according to patient need,” they said.

“Based on the results of this audit, there is likely need for further improvement to individualise opioid prescribing on discharge for all patient cohorts.”

Pharmacists play a crucial role in opioid stewardship, the researchers added.

“It has been shown that pharmaceutical care provided by pharmacists can reduce inappropriate prescribing and encourage quality use of medicines,” they said.

“Pharmacists and other health professionals should ensure emphasis on patient education regarding the risks associated with opioid use and ensure, where appropriate, the short‐term nature of the medication is advised at the point of discharge counselling to the patient.”

On 1 June 2020, changes were made to many opioids and multiple formulations listed on the PBS General Schedule, including new listings for half pack sizes (10 tablets/capsules) and increased restrictions for full pack sizes.

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