Capacity building for prescribers to identify and respond to patients experiencing pharmaceutical opioid use problems

October 2016

NCETA Staff: Ann Roche, Roger Nicholas, Victoria Kostadinov

Project description: 

There is increasing concern in Australia about the inappropriate use of prescribed opioids. The past decade and a half has seen a significant increase in the prescribing of Schedule 8 opioids in Australia. Use of over the counter codeine-containing medicines has also increased during this time.

The harms associated with these trends include iatrogenic dependence, overdose and inappropriate use for persistent non-cancer pain. In addition, there is growing awareness of the potential side effects of long-term opioid use including endocrine and sexual dysfunction, osteoporosis and hyperalgesia. 

Many prescribers are unfamiliar with contemporary evidence-based opioid prescribing guidelines and best practice responses to patients experiencing harmful use.  In addition, many lack sufficient knowledge, skills and confidence to address this issue and/or circumvent problems developing.

Preventing and responding to harmful patterns of pharmaceutical opioid use can represent a significant challenge for many prescribers. Even when aware of appropriate prescribing practices, some prescribers may experience pressure from patients to receive scripts for, or increased dosages of, opioids. This can place prescribers in a difficult position when they do not believe that this is in a patient’s best interest.

To this end, NCETA has developed a project designed to:

  1. Identify the key learning needs of Australian medical prescribers in relation to preventing pharmaceutical opioid-related harms and responding to patients experiencing such harms
  2. Collect and consolidate available evidence from relevant literature and expert opinion concerning best clinical practice in detecting, and responding to, pharmaceutical opioid problems.
  3. Develop resources to inform best practice.
  4. Provide advice concerning the most effective approaches to distribute the resources and to encourage innovation dissemination.

A Project Reference Group is being established to oversee the project and includes representatives from professional bodies such as:

  • The Royal Australasian College of Physicians: Chapter of Addiction Medicine
  • The Australian and New Zealand College of Anaesthetists: Faculty of Pain Medicine
  • The Royal Australian College of General Practitioners.

This project represents an important step in gathering the available international evidence on approaches to preventing and responding to pharmaceutical opioid use problems and applying it to the Australian context.