The future of opioid use

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Tailoring quantities of opioids provided in hospitals as appropriate to patient’s individual needs is a crucial step in harm reduction, says SHPA

Representatives from across the health system, and leading hospital pharmacists, gathered in Canberra this week to identify proven and potential measures to reduce the incidence of opioid harm in patients after surgery.

SHPA’s inaugural Medicines Leadership Forum 2018: Reducing opioid harm invited leaders in key areas of healthcare to discuss preliminary recommendations from Reducing opioid-related harm: An Australian hospital landscape paper.

The SHPA report highlights the importance of developing and expanding consistent high-quality pain management and patient education services at public and private hospitals in metropolitan, regional and remote areas, particularly for opioid naïve surgical patients – and is set to be released in coming weeks with recommendations to improve nationwide opioid management.

SHPA President Professor Michael Dooley says the collaborative forum was an important step toward improving the safe use of opioids, which are commonly prescribed after the 2.2 million surgeries that take place in Australia every year.

“Demand for surgery in Australian hospitals continues to grow, and hospital-initiated opioid use is frequent and can induce long-term misuse or abuse and significant harm,” he says.

“Gathering key representatives from across the health system, including General Practitioners, Anaesthetists, Pharmacists, Pain Management and Addiction Medicine specialists, as well as consumer health and government figures, was crucial to ensuring multi-disciplinary input into our recommendations.

“Stakeholders agreed on the need to work collaboratively to ensure patients are provided the best possible care and that significant gaps and variability currently exist.”

Professor Dooley says a range of strategies were identified that should be implemented including supporting analgesic stewardship, managing medication supply, working with prescribers, empowering patients and supporting transitions of care.

Tailoring quantities of opioids provided as appropriate to the individual needs of patients is crucial to reducing the risk of harm, said Professor Dooley.

“Pharmacists and doctors can play a key role in providing education and feedback to prescribers – empowering patients and supporting all clinicians including General Practitioners during the transition of care is also a key priority.

“These discussions were particularly dynamic as they were informed by current data from 135 public and private hospitals on opioid use and practices, through SHPA’s hospital pharmacy landscape study, which gives us added confidence to collaboratively leverage the most promising initiatives on a state and national scale.”

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1 Comment

  1. Ron Batagol

    This was obviously a very timely and useful summary of the situation regarding appropriate opioid use, especially in the hospital care situation, and ways to achieve this.

    In my own submission to TGA regarding the “opioid use and Misuse” consultation in January this year, I highlighted the following points: .

    To Increase health professional awareness of alternatives to opioids in the management of chronic pain, we need an increased health care professional awareness of alternatives to opioids, and to align these to current clinical guidelines..

    I also suggested that TGA should be encouraged to work with the NPS MedicinesWise and clinical colleges to increase awareness of health practitioners and the uptake of appropriate pain management guidelines in their practices.

    This could include developing a comprehensive repository of information about the appropriate use of both S4 analgesics and the range of S8 opioids, which includes some of the measures already noted and additionally some of the suggestions of the TGA Advisory Committee on Medicines in October 2017, including:

    1. The introduction of smaller pack sizes for strong opioids that may be prescribed when short-term use is required, such as for pain relief after surgery. 2.A review of the approved indications for S8 opioid medicines and align them to current clinical guidelines ( as already noted).
    3.Working with the Health Technology Assessment and Access Division of the Department of Health to consider PBS prescribing restrictions, such as smaller quantities and the requirement for specialist medical review of non-cancer pain patients prescribed opioids for extended periods.

    Obviously, also critical to the success of all these initiatives, is the implementation of a robust national real-time prescription monitoring system.

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