Hobart is Australia's capital city with the highest consumption of the highly addictive and commonly abused prescription opioids, oxycodone and fentanyl. However, while the numbers in the new drug report appear worrying, experts have an explanation.
Five Tasmanian wastewater sites in metropolitan and regional areas were monitored by the Australian Criminal Intelligence Commission between April and August 2021.
The drugs methylamphetamine, amphetamine, cocaine, MDMA, MDA, heroin, cannabis, oxycodone, fentanyl, nicotine, alcohol and ketamine were targeted.
The report found Tasmania had the highest capital city consumption of both oxycodone and fentanyl in the sample period, although the report notes nationally on average "oxycodone consumption remains at historically low levels, although consumption appeared to have stabilised since April 2021".
While prescriptions are required, the highly addictive nature of the drugs — which are used to treat moderate to severe pain — means they are commonly abused.
A 2021 report commissioned by the Therapeutic Goods Administration showed pharmaceutical opioids are now responsible for far more deaths and poisoning hospitalisations in Australia than illegal opioids such as heroin.
The TGA report also found that only around half of consumers (56 per cent) felt they were using opioids safely and around one-third (30 per cent) felt they were dependent on their opioid medication.
As a result, the TGA has restricted the ability of general practitioners to prescribe the drugs, with fentanyl only prescribed to treat pain in patients with cancer, those in palliative care, or patients with exceptional circumstances.
What has DORA got to do with it?
Policy manager at the Alcohol, Tobacco and other Drugs Council Tasmania, Jackie Hallam, said while the statistics looks worrying, there are valid reasons why many Tasmanians use the drugs.
ABS census data from 2020 lists Tasmania as having the oldest population with a little more than 20 per cent of Tasmanians aged over 65.
And while an ageing population can explain the rise in pharmaceutical opioid use, it is clear more needs to be done regarding the best practice for prescribing.
In 2009, Tasmania was leading the other states by being the first to implement a real-time prescription monitoring system named DORA (Drugs and Poisons Information System Online Remote Access).
DORA was intended to be a system where doctors could log prescriptions and track patients who had a history of drug abuse.
However this vision was never realised, and DORA — which is not mandatory — is set to be discontinued later this year in favour of a new prescription monitoring system.
AMA Tasmania spokesperson Dr Annette Barratt said work had been done on better prescribing of the drugs, but admitted the system was less than ideal.
"Tasmania has had significant problems with opioid prescribing in the past, but in recent years efforts have been made to educate doctors about the dangers and improve the overall prescribing across the state.
"In many other states, software to check on a patient's previous opioid usage must be compulsorily checked before prescribing. In contrast, in Tasmania, the software, DORA, is optional. However, its use has increased markedly, and inappropriate prescribing rates have been reduced."
Dr Barratt said the compulsory software was going to be introduced in 2020 but had been delayed.
"The Pharmaceutical Services Branch monitors prescribing and follows up with doctors who don't follow recommendations. However, unfortunately, this is in retrospect at present. The change to the new software will help this," she said.
Tasmanian chair of the Royal Australian College of General Practitioners Tim Jackson said "we've known that we have high instances of opioid prescriptions in Tasmania for quite a while now".
Dr Jackson said over the past ten to fifteen years opioid prescriptions for chronic pain, mainly to improve activity levels, were promoted.
"We've still got some people who commenced on opioids back then [who] are still on them now," he said.
"Nowadays, we wouldn't use opioids as first-line treatment, because we know they're drugs of dependence, and can be taken in overdose which in some instances causes death. But generally there has now been a change in the way we treat chronic pain."
While improvements in systems are planned, the workload on GPs has also been flagged as a danger.
Two coronial reports into the deaths of two Tasmanian women in 2018 noted both women were prescribed opioid drugs before their death.
Coroner Olivia McTaggart wrote in her findings that those responsible for prescribing the drugs did not follow correct protocols.
"Unfortunately, coroners often encounter cases where doctors regularly prescribe Schedule 8 substances without current authorities from PSB to do so, no doubt due to workload issues or insufficient attention to the expiration of the authority," she said at the time.
Dr Jackson said the time frames for patient consultations were "always a problem".
"Medicare hasn't kept up with the times, and doesn't reward longer consultations that some GP's require to properly look after their patients."
While it is hoped the new TasScript system would make it easier for GP's to identify cases of drug abuse or potential addiction risks for oxycodone and fentanyl, it is not the only challenge facing Tasmania.
The ACIC report also found Tasmania had the highest average regional area "excretion" of ketamine, a 26 per cent increase in heroin consumption and 31 per cent increase in cocaine detections — the only Australia jurisdiction to register a rise on last year's result.
Tasmania was also found to have the second highest consumption of alcohol and nicotine use in the country, with cocaine consumption surging by 31 per cent from the previous year.
Dr Jackson said people who have alcohol, nicotine, and "any other drug problems" — including a dependence on opioids — should consult their GPs and develop a treatment plan to help get them back on track.
"It is always good to start with your GP, as generally they know you better."
