The health sector needs a “fundamental re-education” around the use of analgesics in chronic pain, says AMA president Dr Michael Gannon
And doctors have been over-prescribing opioids over recent years, he admits.
Following the release of the AIHW’s report on the misuse of pharmaceutical drugs, Dr Gannon spoke to 2GB’s Mark Levy, who asked him whether making low-dose codeine prescription-only would solve the problem.
“Doesn’t this research show that making something prescription only won’t actually fix the problem?” asked Mr Levy.
“And when you look at codeine addiction, it exists in just 0.011% of the population. Surely you can’t punish the other 99% of the population. There must be better ways.”
Mr Gannon replied that Australia needs a fundamental re-education across the medical profession as well as the community, “that drugs that are designed for acute pain have no role in chronic pain”.
“So, whether you’re talking codeine, phosphate, four milligram tablets or 30 milligram tablets, that is not a useful drug for chronic pain syndromes,” Dr Gannon said.
“We need to get these people in to see experts in pain medicine, experts in addiction medicine. They’re two areas where we need to see more resources going, and we need to see that change.
“We’ve got a problem with opioid abuse, and that is across the board, whether you’re talking about people who start off with over-the-counter codeine, the higher doses prescribed by my colleagues, or whether you’re talking about illicit use of fentanyl, oxycodone, or heroin.”
Dr Gannon said that the Pharmacy Guild’s MedsASSIST program did not have the reach or coverage required to combat the problem.
“Doctors have a responsibility,” he said.
“We have overprescribed oxycodone, codeine, other powerful opioids in recent years, but part of what’s involved is getting our patients to a greater understanding of the fact that these are not the answer, beyond short-term use of pain relief, for example, after surgery.”
The Pharmacy Guild of Australia also responded to the AIHW report, saying it highlights an urgent need for real time monitoring.
Its national president, George Tambassis, highlighted that the report showed a 24% spike in prescriptions for opioids between 2010-11 and 2014-15. This rise was underpinned by a 60% increase in prescriptions for oxycodone.
“Demonstrably there is a need for mandatory national real-time recording of medicines which are subject to abuse and dependence or cause harm,” he said.
“Such a real time recording system must operate across pharmacies and doctors’ surgeries to be effective.
“Greater vigilance and better exchanges of information among health professionals is also clearly needed.”
He said that as MedsASSIST will become redundant from 1 February, the lack of a national system in place to monitor scripts for codeine remains a significant concern.
He also said that the Guild was worried about the lack of post-hospital reconciliation of medicines use.
“Simply giving patients a big bag of medicines when they leave hospital is just not appropriate and the transition from hospital to home or care is where much of medication misuse can arise,” he said.
“Building community pharmacies into this transition is essential. Pharmacists are the medicines experts and community pharmacies are easily accessible to help patients manage their medicines when they leave hospital rather than leaving them to self-manage.
“A structured transition plan with community pharmacists at its core can help prevent a problem from occurring rather than leaving it till the patient becomes a statistic in reports like this latest one from AIHW.”
In its pre-Budget submission the SHPA also highlighted the gap between hospital and community care for high-risk patients, and called for the development and funding of a new care model to help them. People using opioids to treat chronic pain would be among several key targets for such a service, SHPA says.
“Research from Queensland Health presented at Medicines Management 2017 demonstrated that some issues prevalent at the transitions of care include misunderstanding of reducing analgesic dose plans, as well as the absence or delay of handover to the patient’s GP for pain management,” the submission states.
“Medication reviews after discharge from hospital improve the understanding of dosing schedules, so patients can successfully wean off opioids completely or reduce their dosage, therefore reducing the incidence of developing dependence.”