Opioids for chronic pain? #Notwise

Painaustralia and ScriptWise have partnered to support new recommendations aimed at reducing prescribing of opioids for chronic pain. 

An intiative of the NPS Medicinewise Choosing Wisely, the recommendations urge doctors to “not prescribe opioids for the treatment of acute or chronic pain” without conducting a thorough investigation and looking at the alternatives. The risks, they say, “may outweigh the benefits given there is also insufficient evidence on whether the pain relief provided by opioids is sustained in the long term”.

Between 1992 and 2012, opioid dispensing increased 15-fold (500,000 to 7.5 million) and the corresponding cost to the Australian Government increased 32-fold ($8.5 million to $271 million), while opioid-related harms, hospitalisations and accidental deaths also increased.[1] 

With the latest general practice data showing that an opioid is prescribed for three in four cases (72%) of multisite management,[2] the rate of opioid prescribing for chronic non-cancer pain is contributing to this – despite evidence of their ineffectiveness for long-term pain and risk of abuse, dependence and overdose – and it’s something we need to change.

“There is a misunderstanding that opioids benefit chronic pain.  We need to ensure better awareness and provide more effective support for people with chronic pain if we are to reduce misuse of opioid medication in Australia.  Dependence and unwanted side-effects can have a devastating impact on people’s lives,” said Painaustralia CEO Carol Bennett.

“Lack of referral options and insufficient pain services have contributed to this problem and the status quo will remain until we have a national, coordinated approach to providing best-practice multidisciplinary care in a timely manner.”

ScriptWise CEO Bee Mohamed says the conversation needs to change. "The conversation needs to be around supporting patients in managing their pain without opioid painkillers as the first option.  The number of fatalities relating to opioid painkillers has been on the rise in Australia, and it is clear that more needs to be done so that that patients are well-aware of the potential devastating consequences of these medications."

Simply telling doctors to stop prescribing opioids, however, is not enough.  Painaustralia and ScriptWise are calling for:

• a public awareness and education campaign for consumers;
• better education for doctors and other health professionals;
• improved access to pain services (especially in regional and remote Australia);
• improved access to affordable specialised allied health services; and
• clear pathways for referral using a team-based approach in the primary health care setting.