Experts have highlighted the “dramatic increase” in opioid prescribing in Australia, saying pharmacists are in an ideal position to help manage the issue
In an accepted manuscript for the journal Research in Social and Administrative Pharmacy, chronic pain and analgesic experts have warned of a concerning increase in opioid prescribing and concomitant development of tolerance and withdrawal symptoms.
Experts presented on aspects of chronic pain and analgesic use in older Australians at Monash University’s inaugural conference for ‘Best Practice in Chronic Pain Medication Management’, which was held in December 2016.
In a follow-up article on the topics discussed at the event, authors from Monash University, Alfred Health, St Vincent’s Hospital Melbourne and the Department of Health and Human Services point out that the number of opioid scripts subsidised by the PBS almost tripled between 1992 and 2007 (from 2.4 million to 7 million).
In addition, an almost seven-fold increase in oxycodone-related deaths in Australia was observed from 2001 (21 deaths) to 2011 (139 deaths).
The three largest volumes of opioid dispensing were observed in people aged at least 60 years old, and there has been a significant increase in prescribing of analgesic for patients with chronic pain.
“This is despite insufficient evidence (e.g. for opioids) or evidence of no benefit (e.g. paracetamol/acetaminophen for non-specific low back pain), for long-term use of specific analgesics and chronic pain conditions,” according to Alfred Health clinical pharmacist Eleanor van Dyk.
Meanwhile increased opioid prescribing has been accompanied by problems with abuse and addiction, increased risk of death from overdose or suicide, potentiation of sedative effects with concurrent use of anxiolytics/hypnotics, medication diversion, as well as medication dispensing errors.
According to Australian Coroner reports, opioid-related deaths are increasing although the true extent of the problem may be underreported, says Monash University’s Dr Jennifer Pilgrim.
In response to codeine misuse and abuse in Australia, measures to restrict OTC codeine availability are being employed, which may escalate the potential for pharmacists to discuss opioid-related concerns with patients, say Professor Colin Chapman from Monash University, who is also a Victorian community pharmacist.
Real-time prescription monitoring is another solution being implemented, which may work towards identifying patients at risk of medication misuse.
Other ways pharmacists can contribute towards addressing chronic pain medication management in older populations include being aware of relevant guidelines, completing further training, contributing to policy and guideline development, participating in panels, working groups and pain management teams, collaborating on research projects, and educating the community, say the study authors.
“With regards to opioid medication management, pharmacists are in an ideal position to: monitor prescription dispensing and potential misuse, provide education about overuse and, if appropriate, provide access to naloxone,” they say.
“Pharmacists are in a position to positively influence the major health and social problem associated with inappropriate medication management of chronic pain and opioid analgesic use.”
They add that pharmacists require continuing education in order to equip them with the necessary knowledge and skills to optimise chronic pain management.
In response to a recent Channel 7 Sunday Night segment on prescription opioid addiction, which described thousands of Australians “hopelessly hooked” on strong pain killers, PSA National President Dr Shane Jackson said on Twitter that there is a “need for comprehensive solutions to pain, real time prescription monitoring, better support for prescribers and restrictions on quantities and doses to prevent addiction from inappropriate prescribing”.
PSA Victoria Vice-President Jarrod McMaugh said there is a need for “more resources for pharmacists to do their job [to] protect patients from inappropriate prescribing.
“[And] more education for prescribers on the role of pharmacists so they respect the purpose of the phone calls they will receive about risky prescribing.”
See the RSAP article here.