Opioids issue needs holistic response

Painaustralia hears many stories about people with chronic pain, and how cessation of inappropriate opioid use and a multidisciplinary pain management approach resulted in enormous improvements in mental health and function. They are people like Peter, Chris, Mary-Lynne, and many others.

Despite the benefits of this approach, access to best practice care for chronic non-cancer pain remains difficult and unaffordable, which has an impact on opioid prescribing.

The Australian Institute of Health and Welfare reported that opioid prescribing rose 24 per cent between 2010-11 and 2014-15, from 369 to 456 prescriptions per 1,000 population, and we know from the Australian Atlas of Healthcare Variation that opioid prescribing is higher in rural and remote areas.

Fortunately this issue is now getting the attention it deserves. The Therapeutic Goods Administration (TGA) has progressed its consultation process on a regulatory response to prescription (Schedule 8) opioid use and misuse in Australia, and the Faculty of Pain Medicine (FPM) also recently held an opioids forum (see July’s Australia Pain Society newsletter p5).

At the TGA consultation forum, attended by Painaustralia and other key stakeholders, experts agreed that while the increasing and inappropriate use of opioids needs to be addressed in Australia, we also need to be cautious of unintended consequences of blunt regulation in the absence of consumer awareness and health professional education and training.

Presenters at the FPM forum reminded participants about the limitations of opioids for chronic pain, while Ms Aine Heaney from NPS Medicinewise suggested that education alone is insufficient in changing prescribing behaviour based on the PBS prescription data.

In our submission to the TGA, we outlined how the opioids issue highlights the need for a holistic response, underpinned by a national strategy to better prevent, treat and manage pain.

While there is a lack of definitive evidence supporting the long-term effectiveness of opioids for chronic pain, as well as substantial evidence of potential harm, changes to opioid prescribing will have ramifications to the people who currently use it for chronic pain conditions.

Reform must consider better education in quality use of medicines and best practice pain management, and address essential improvements in access arrangements. These key issues will inform an important part of our National Action Plan on Chronic Pain Management.