Measures to curb growing rates of opioid use are also making it difficult for people with long-term, chronic pain to get ongoing prescriptions.
Australians live with chronic pain lasting three months or more. back and neck pain, headache, and joint pain.
Opioid medicines – such as oxycodone, morphine, fentanyl and codeine – are essential medicines and to many people with this type of pain.
However, opioids can also cause and including dependence and , which may be .
Over the past decade, measures have been introduced in Australia to curb growing rates of opioid use and harms. But this has come at the expense of access for some people who genuinely need them.
In our , one-third of participants prescribed opioids long-term for chronic, non-cancer pain had difficulties getting ongoing prescriptions.
In 2018, was made a “prescription-only” medicine. In the same year, Australia’s Chief Medical Officer prescribing a lot of opioids to encourage them to consider reducing their prescribing.
States have also , allowing providers to see whether their patients are getting opioids from other doctors or pharmacies.
In some states, doctors and pharmacists can check if patients are getting scripts elsewhere.
We’re undertaking a of just over 1,500 Australians prescribed opioids for chronic non-cancer pain. We started asking questions about accessing opioid prescriptions in our 2018 interviews with participants.
These weren’t prescriptions for new pain conditions, but ongoing prescriptions for people who had been , on average, and living with pain for ten years, before the study.
Over the past 30 years, the amount of opioids (doses per Australian per day) dispensed on the Pharmaceutical Benefits Scheme (PBS) .
There has also been a in opioid prescriptions dispensed on the PBS between 1995 and 2015. Australia among .
As opioid use has risen, . Opioids are the in drug-induced deaths.
Pharmaceutical opioids are now involved in . Pharmaceutical opioids also contribute more to than heroin, with hospitalisations doubling since 1999.
In , one in five people reported problems relating to accessing doctors.
As opioids become more restricted, people may need to visit their doctor more frequently because they’re given smaller pack sizes and fewer repeats. They may be put in a position where they’re unable to get prescriptions if doctors aren’t available.
Opioids can cause and tolerance with continuous and long-term use. However, sudden interruptions to opioid medicine supply may place people at risk of experiencing such as nausea and vomiting, flu symptoms, and muscle cramping.
One in ten people in our study reported their doctor wanted to reduce or stop opioid medicines against their wishes.
Ceasing opioids needs to be undertaken carefully.
More doctors are practising “opioid tapering” (reducing opioid doses over time), especially in the United States, the release in 2016 of Centers for Disease Control and Prevention (CDC) for chronic pain.
However, there were soon reports of opioids being ceased , which risks withdrawal. This that applying guidelines without adequate care could harm patients.
Worryingly, studies have linked stopping or reducing opioids with death by , even for to begin with.
These studies also found people who stopped opioids were more likely to visit the emergency department or be admitted to hospital for , and .
For some people, reducing or stopping opioids will be the right thing for them, clinically. Some studies suggest without increasing pain.
Some studies suggest when . However, participants in these studies are usually enrolled in special pain programs. These programs are notoriously difficult to access in Australia and it is for services. in pain services and programs is needed.
There is also a need for opioid tapering to be undertaken in a , with patients and doctors working as a team to achieve .
Since we conducted our study, new in 2020 reduced the quantities of opioids that can be prescribed on the PBS. For most opioids, doctors can only supply quantities and repeats for up to three months at a time.
So it’s likely to have become harder for people with pain to access pain medicines. In a survey released last month by Painaustralia, half of the respondents said , and their pain was more severe, because of the changes.
Opioid harms need to be recognised and addressed, as does pain.
When it comes to using opioids for chronic non-cancer pain, it’s important to balance both benefits and harms. Potential opioid-related harms need to be recognised and addressed. At the same time, adequate treatment of pain is essential, and we need to make sure people don’t suffer harms due to changes to opioid access.
The needs of people who live with pain and the impact of restrictions on them need to remain at the centre of all decisions and discussions about opioids.
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, PhD Candidate, National Drug and Alcohol Research Centre, and , Clinical pharmacist and Scientia Senior Lecturer at the National Drug and Alcohol Research Centre,
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