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.
“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.
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.”
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.
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.
“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.