Assessing and responding to patients with pharmaceutical opioid-related problems

August 2018
Nicholas, R. (2018). Responding to problems related to pharmaceutical opioids: A resource for prescribers. National Centre for Education and Training on Addiction (NCETA), Flinders University, Adelaide.

Prescribers in Australia are likely to see increasing numbers of patients experiencing difficulties with pharmaceutical opioid use. They are also likely to become more cautious about continuing to prescribe opioids (particularly in high doses) to their patients. There are three reasons for this:

  1. Increasing community and professional concerns about the burgeoning harms associated with pharmaceutical opioid use in Australia. These harms include hospitalisations, iatrogenic dependence, adverse physical effects and deaths.
  2. Increasing community and professional awareness about the lack of efficacy of pharmaceutical opioids for the treatment of persistent non-cancer pain (PNCP). The use of opioids is not only associated with the harms outlined above but also results in lost opportunities for more effective pain treatment.
  3. Recent regulatory changes have impacted the availability of over-the-counter (OTC) codeine. On 1 February 2018, medicines containing low-dose codeine (most importantly compound analgesics) became unavailable from Australian pharmacies without a prescription.

In recognition of all these factors, NCETA was funded by Indivior Pty Ltd to develop a resource for prescribers (see accompanying News item in this edition). NCETA also undertook a literature review to inform the development of that resource.

NCETA’s literature review found that:

  • Up until the 1980s, pharmaceutical opioids were probably under-prescribed in Australia
  • The 1990s saw a revolution in the use of opioids to treat acute and malignant pain
  • The 1990’s saw an exponential growth in the use of pharmaceutical opioids to treat PNCP despite their lack of efficacy for these conditions
  • There is now greater recognition of the harms associated with pharmaceutical opioids use and a more comprehensive evidence base about their lack of effectiveness for PNCP resulting in their more judicious use
  • The implementation of an online, real-time Electronic Recording and Reporting of Controlled Drugs (ERRCD) system will provide prescribers and dispensers with information regarding their patients’ use of these medicines
  • It is important that people who have encountered difficulties as a result of previous approaches to pharmaceutical opioids are provided with appropriate support e.g. the use of non-pharmaceutical or non-opioid treatments for pain management.

The findings of this literature review highlight the importance of assisting prescribers to assess and respond to patients with pharmaceutical opioid-related problems. The literature review will be available for download from the NCETA website later this year.