Opioid epidemic has reached Australia

Research by the Centre for Medicine Use and Safety (CMUS) at the Monash University Faculty of Pharmacy and Pharmaceutical Sciences has found that a staggering 1.9 million Australian adults begin taking prescription opioids every year.

In a paper published in the British Journal of Clinical Pharmacology, a team of researchers involving Austin Health pharmacist and CMUS PhD candidate Samanta Lalic has analysed the dispensing of opioids through Australia’s Pharmaceutical Benefits Scheme from 2013 to 2017.

The CMUS research comes just days after the Australian Institute of Health and Welfare (AIHW) released a report revealing that deaths involving opioids have nearly doubled in the last 10 years in Australia. Overdose from prescription medicines has already overtaken road deaths and illicit drug overdose as a cause of death in Australia.

The paper comes at a time when the use of prescription opioids in the USA is routinely described as a “public-health crisis” and an “epidemic”, with more than 130 people dying every day from opioid-related drug overdoses in 2016 and 2017.

Ms Lalic’s research not only reveals just how many Australians are being dispensed opioids, it also finds that 2.6% of them – or around 50,000 people – become long-term users over a year. Of concern, an increasing proportion of patients are being started on stronger opioids.

According to Ms Lalic, this is where the real cause for concern lies, because both long-term use and the use of strong opioids are associated with a range of adverse health outcomes. In addition to overdose deaths, high-dose opioid use has been associated with falls, fractures, hospitalisations and motor vehicle accidents.

“Opioids do have an important role in managing cancer pain and acute non-cancer pain. However, their use remains less well established for chronic – i.e. long-term – non-cancer pain,” Ms Lalic said.

“For the treatment of chronic pain, we need to change prescribing culture and raise the level of awareness of other treatment options among patients. The goal of care, treatment expectations and intended duration should be agreed upon by patients and prescribers prior to opioid initiation.

“In many cases the safest and most effective way to treat chronic pain will involve a combination of therapies, including exercise, physiotherapy and non-opioid painkillers.”

Ms Lalic said the next step is to determine how prescribers and patients escalate doses over time.

“This is important because international research has demonstrated a strong link between prescribed dose and overdose deaths,” Ms Lalic said.

Last year Australia’s Therapeutic Goods Administration called for consumers and health professionals to provide input into strategies to address high rates of opioid prescribing.

(Source: Monash University, British Journal of Clinical Pharmacology)