Australian doctors will be encouraged to consider alternatives to prescribing opiates to protect patients from becoming addicted or overdosing on the medication.
New standards of care released on Wednesday by the Australian Commission on Safety and Quality in Health Care establishes a national standard for prescription of opioid analgesics in emergency departments and after surgery.
Doctors will be asked to consider alternatives, and if opioids are required they will be asked to create a plan to wean patients off the drugs.
Some 2.5 million Australians undergo surgery every year, and 70 per cent of hospitals discharge patients after surgery with opioids “just in case”, according to a national survey.
More than three million people are dispensed at least one opioid prescription a year, including oxycodone, morphine, buprenorphine, hydromorphone, fentanyl, tapentadol, tramadol or codeine, under various names.
The commission’s Chief Medical Officer Anne Duggan says opioid analgesics are effective for pain relief but people given prescriptions are at risk and need ongoing care.
“We need to fine-tune our prescribing and use of opioid analgesics for acute pain, to reduce the harms associated with inappropriate prescribing and avoid short-term use becoming a long-term problem,” Prof Duggan said.
Balancing adequate pain relief and the risk of patient harm was not easy, she said.
“It is critical that when patients are discharged from hospital, there is a discussion with the patient and a clear medication management plan to wean off opioids,” she said.
Anaesthetist and pain management specialist at Sydney’s St Vincent’s Hospital Jennifer Stevens said there was a large variation in how opioids were used.
The clinical care standard encourages simple analgesics like paracetamol and anti-inflammatories, and non-medication for mild and moderate levels of pain, Associate Professor Stevens said.
Severe and acute pain could be controlled with judicious use of opioids.
“As prescribers, doctors have an ‘opioid-first’ habit that we need to kick,” she said.
“Compared to many European and Asian developed nations, Australia places a high reliance on using opioids as first-line analgesia, despite evidence those countries with significantly lower reliance do not have poorer pain outcomes,” she said.
The Therapeutic Goods Administration introduced regulatory reforms for opiates in 2018 to limit harm, including changes to the Pharmaceutical Benefits Scheme and introducing smaller packet sizes for immediate-release drugs.
Data suggests the changes have reduced Australia’s use of opioids.
