‘Most widely misused’: benzos, opioid analgesics

A new report tabled in Victorian Parliament has highlighted misuse of pharmaceuticals as the leading cause of drug-induced deaths in Australia

The Victorian Parliament’s Law Reform, Road and Community Safety Committee has handed down a report relevant to its Inquiry into drug law reform in the state.

While looking into several areas of both licit and illicit drug use, and different approaches towards drug policy, a significant section of the report was dedicated to the misuse of pharmaceutical drugs across the country.

The Committee examined evidence from the 2016 National Drug Strategy Household Survey, which found approximately one million people aged 14 years or over (roughly one in 20 Australians or 4.8% of the population) reported misusing a pharmaceutical in the previous 12 months.

Judge Sara Hinchey, State Coroner of Victoria, provided evidence to the Committee that pharmaceuticals contributed to approximately 80% of all overdose deaths each year between 2009 and 2016.

Judge Hinchey also stated that in a study of 838 overdose deaths involving pharmaceutical drugs, the vast majority of these drugs were prescribed to the deceased rather than diverted or purchased over the counter or imported via the internet.

The Coroners Court’s submission provided further details regarding the contribution of pharmaceuticals to overdose deaths, with benzodiazepines the most frequent contributor followed by opioids and antidepressants.

“Alarmingly, the misuse of pharmaceuticals is the greatest contributor to drug-induced deaths in Australia, with a disturbing rise in such deaths across Victoria and the country,” the Committee found.

The Penington Institute recently noted rising rates of overdose deaths due to fentanyl in a 2017 report, which stated that “deaths from fentanyl across Australia has risen nearly 800% (an eight-fold increase) over the ten-year period from 2001-2005 to 2011-2015”.

And according to a report by the Australian Institute of Health and Welfare, the number of opioids prescribed in 2014/15 rose by 24% from 2010/11, reaching a rate of 45,600 prescriptions per 100,000 population (an overall figure of 11.12 million prescriptions on the PBS).

The most commonly prescribed opioid is oxycodone, which represented approximately one third of all opioid prescriptions dispensed (an increase from 27% of prescriptions in 2010/11 to 34 per cent in 2014/15), according to the inquiry report.

Oxycodone prescriptions increased 60% from 2010/11 to 2014/15, from 9,800 to 15,500 per 100,000 population.

Noting similar increases across a range of other opioids such as fentanyl and tramadol – although codeine rates remained stable – the AIHW report stated that substantially more opioid analgesics are being prescribed and dispensed than previously.

The Committee referred to evidence indicating that rather than many doctors adopting inappropriate prescribing practices, it is more likely that there are a small number of doctors doing so at high rates.

Given the contribution of pharmaceutical drugs to a range of increasing harms across Australia, the Committee received evidence from stakeholders on various strategies to reduce reliance on these drugs in the community.

There is a need for prescribers and pharmacists to be empowered and informed in their decision-making, said the Committee.

It adds that, despite high rates of prescriptions in the community, there appears to be a lack of evidence to demonstrate the effectiveness of commonly misused pharmaceuticals to treat a range of conditions.

Dr Alex Wodak AM of the Australian Drug Law Reform Foundation told the Committee: “We have to convince the community and doctors that the prescribing of prescription opioids for severe, chronic, non-malignant pain is very marginal. It does help some people but there are a lot of people who it has no benefit for and a lot of people it has significant side effects for.”

The Committee also highlighted the Pain MedsCheck trial through community pharmacies, to support people taking medications for chronic pain issues for three or more months.

“Such a model may provide further guidance on how to manage prescription, dispensing and use of pharmaceuticals in community settings, which the Committee notes is a key aspect of stewardship frameworks,” it said.

“Based on this evidence, the Committee believes there is strong merit in exploring the feasibility of the broad implementation of a stewardship framework approach which targets the most commonly misused pharmaceuticals – opioids and benzodiazepines.”

Committee recommendations into pharmaceutical drug law reform include: developing opioid medication guidelines for GPs; developing and promoting a stewardship trial program for analgesics and benzodiazepines; developing resources and conducting community awareness campaigns; and adopting measures to ensure effectiveness of the real-time prescription monitoring (RTPM) system.

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