Prescription opioid rates ‘astonishing’

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Several stakeholders have expressed concern about a newly documented rise in opioid use

The Third Australian Atlas of Healthcare Variation, released on Tuesday, found that between 2013–14 and 2016–17 the rate of opioid medicines dispensing per 100,000 people increased by 5% nationally.

The magnitude of variation in dispensing rates also increased, from 4.8-fold to 5.1‑fold.

It is unclear whether these changes are due to more people requiring opioids for appropriate uses or an increase in inappropriate prescribing.

Despite the number of regulatory efforts already in place to minimise harm from these medicines, continued focus on improving medicine use in this area is needed.

In 2016 to 2017 there were 58,595 prescriptions dispensed per 100,000 people, an increase from 2013-14, when this was 55,900 prescriptions per 100,000.

However Jarrod McMaugh, pharmacist and president of Chronic Pain Australia, recommended caution when interpreting and acting on these figures.

“While the use of opioid analgesics is far from ideal as an ongoing treatment for pain, it is important to remember that changes to a person’s medications should be made in a collaborative discussion between that person and their team of health professionals,” he told the AJP.

“Changes to treatment plans should be made with the individual in mind, not the national trend.

“Australians who are in pain do not want to see a situation like the one occurring in the United States where clinicians are ceasing medications for fear of prosecution, rather than the best interests of their patients.

“Government funding for people in pain currently promotes the use of medications by limiting funding for allied health providers who’s services are proven to positively impact chronic pain.

“While the federal government limits access to these services, many people in pain are left with few options than to utilise PBS-funded medications.

“Until all options for the treatment of pain are funded equitably, people in pain will continue to utilise medications as their primary source of pain relief.”

PSA National President Shane Jackson said that pharmacists could help improve medication safety and quality to reduce the potential harms of opioids.

“The Chronic Pain MedsCheck Trial funded by the Australian Department of Health is an important step towards improving opioid use,” he said.

Pain Australia CEO Carol Bennett expressed concern about the rise in prescription opioid use, calling the figures “astonishing”.

She said that there is growing concern that opioids are being prescribed past the acute pain period and for chronic non-cancer pain.

“We need better awareness among consumers and doctors about  pain management treatment options – and we need to ensure those options exist,” Ms Bennett said.  

“Where pain medication is prescribed, people living with pain will also benefit from a multidisciplinary approach to their care, such as a physiotherapist, psychologist, occupational therapist or other allied health services.

“However, there are significant barriers for most people to access this level of care; one is the cost and the other is geographical location with allied health notoriously scarce in regional areas.”


Other medicines

The Atlas also highlighted issues of inappropriate use of antipsychotics in older Australians.

It pointed out “grave concern” that they were being used to manage behavioural symptoms such as dementia or delirium, and recommended changes to regulations that could improve the use of these medicines.

The Atlas found that, between 2013–14 and 2016–17, there was no decline in the use of antipsychotic medicines in people aged 17 years and under or in people aged 18–64 years, nationally.

The rate of antipsychotic medicines dispensed per 100,000 people in both these age groups increased by 8–9% during the four-year period. The magnitude of variation in dispensing has decreased, but is still considerable.

For people aged 65 years and over, prescription rates of antipsychotic medicines decreased during the four years; however, the volume of antipsychotic medicines supplied on any given day in the Australian community remained stable, indicating that there has been little change in the overall amount of use during the four years.

Between 2013–14 and 2016–17, the rate of antimicrobial prescriptions dispensed per 100,000 people nationally decreased by 9%. The magnitude of variation in dispensing rates increased from 4.6-fold to 4.8-fold.

The reduction in dispensing rates has had little effect on the overall volume of antimicrobials supplied on any given day in the Australian community during the four-year period.

The Atlas found that, between 2013–14 and 2016–17, dispensing rates for amoxicillin fell. However, rates of amoxicillin–clavulanate dispensing did not fall in line with this.

There has also been little change in the volume of either of these antimicrobials supplied on any given day in the Australian community, suggesting that there has been little change in the overall amount of use during the four years.

Further efforts to improve use of these antibiotics and antimicrobial use more generally are needed, the Atlas found.

Dr Jackson said the overuse of medicines such as antibiotics, opioids and antipsychotics demonstrates how the health system needs to change so healthcare professionals such as pharmacists can deliver the right care to the people who need it most.

“Pharmacists are the medicines experts who can make sure medicines are used safely and effectively in residential aged care facilities,” he said.

Dr Jackson welcomed the recommendation in the report for a pharmacist to conduct a medicines review after six months, with the outcomes to be provided to the treating general practitioner and placed on the medication record for people aged 65 years and over being prescribed antipsychotic medicines in aged care.

“PSA has called for pharmacists to be embedded in residential care facilities to reduce inappropriate medicine use and help address the overuse of opioids and antipsychotics,” Dr Jackson said.

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