The Australian Commission on Safety and Quality in Health Care (ACSQHC) is encouraging Australia’s healthcare professionals to reconsider opioid treatment as it is currently administered.
At least one prescription for opioids is dispensed to more than three million people annually, according to 2016-2017 statistics collected by the Australian Institute of Health and Welfare. However, although opioids are effective in relieving pain, long term use of the drug can have serious side effects such as addiction and unintended overdose.
The ACSQHC is launching the Opioid Analgesic Stewardship in Acute Pain Clinical Care Standard, to outline appropriate uses of opioids for emergency and surgery aftercare staff. The new standard urges doctors to administer alternative pain relief where possible and, if opiates are used, to establish an aftercare program to wean the patient off the drug.
Honorary Professor at the University of Newcastle and ACSQHC Chief Medical Officer Anne Duggan said in a commission media release that there is an absence of patient aftercare in current opioid treatments.
“Opioid analgesics are incredibly effective in providing pain relief for severe acute pain,” she said. “However, we must remember that these medicines can have significant adverse effects and may put people at risk of harm after they leave the hospital.
“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.”
Duggan said that the balance between avoiding excessive dependency on opioids and achieving sufficient pain relief to prevent patients from suffering unnecessarily is not easily accomplished.
“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.
The American Society of Anesthesiologists defines opioids as drugs that attach to a receptive protein on nerve cells, blocking messages of pain, sent from the body through the spinal cord, from reaching the brain. Drugs such as fentanyl, codeine, tramadol, morphine, oxycodone, hydromorphone, buprenorphine, and tapentadol are all opioids and are distributed under many names.
Honorary Assistant Professor at the University of New South Wales, Dr Jennifer Stevens, Anaesthetist and Pain Management Specialist at St Vincent’s Hospitals Sydney, said that Australia’s opioid prescriptions are largely varied. Stevens said that the new standard would ensure that every patient is provided safe, evidence-based, and effective opioid prescriptions by setting out guidelines for prescribing parties.
“As prescribers, doctors have an ‘opioid-first’ habit that we need to kick,” Stevens said.
“The clinical care standard encourages the use of simple analgesics such as paracetamol and anti-inflammatory medicines and non-medication techniques for mild to moderate pain,” said Stevens.
The doctor noted though, that for severe acute pain, “the standard recommends judicious opioid use.”
Evidence of this ‘opioid-first’ habit was provided in a national anonymous online survey of hospital pharmacists conducted by the Society of Hospital Pharmacists of Australia (SHPA) in May 2018. The survey involved 135 hospital facilities, both public and private, and was intended for Directors of Pharmacy, or their delegates, who are usually responsible for managing pharmacy policy, procedure and hospital practice.
The survey found that 70 percent of the surveyed pharmacists would more often than not send surgery patients who had not required opioids during the 48 hour period prior to their discharge home with the narcotic “just in case”.
Additionally, comments from the survey indicated that the amount of opioids prescribed depends on not just the patient but the prescriber and, occasionally, the confidence of the pharmacist.
Unsafe after-surgery practices are not insignificant in Australia as over 2.5 million surgeries take place annually, according to 2017-2018 statistics collected by the Australian Institute of Health and Welfare.
Stevens said that many other nations across Europe and Asia depend significantly less than Australia on opioids for their first-line pain relief medication and yet do not demonstrate evidence of poorer pain outcomes.
Orthopaedic Surgeon at Dubbo Base Hospital NSW and North Shore Private Hospital Sydney, Dr Andrew Sefton, said that considering how and when opioid treatment will end is important for prescribing doctors to do.
“It might be quick and easy to provide a repeat on an opioid prescription when we have a patient experiencing pain, but we need to reflect on the individual patient to ensure the benefit outweighs risks,” Sefton said.
“The clinical care standard highlights the need to support the transition of care into the community, with communication and plans for opioid cessation.”
“Providing the patient’s GP with a plan outlining the expected duration of opioid use and the amount of opioids supplied is a practical way to work together,” he said.
Duggan said that the ACSQHC hopes that the new standard will make Australia more considerate of how opioids are used in hospitals, securing the safety of recovering patients as they return to their activities within the community.
“It is ironic that a medication that is designed to reduce pain for patients can, in turn, create long-term anguish for an individual who becomes a persistent user of opioid analgesics once they leave hospital,” she concluded.
It should be noted that the ACSQHC does not stand alone in the fight against Australia’s opioid reliance. The Therapeutic Goods Administration has been introducing regulatory reform for the medication to limit inappropriate prescribing since 2018.
The reform so far has included decreasing the pack sizes of immediate-release opioids and, in June 2020, changing listings of the narcotics on the Pharmaceuticals Benefits Scheme, a list of government-subsidized medications.
Data suggests that the administration’s reform was successful in decreasing opioid use, indicating that the new standard, which is similar in strategy, should also help Australia reduce the use of the drugs further.