A “concerning” rise in prescription opioid poisoning in Australia highlights the need for a national real-time prescription monitoring system, concludes the first national report documenting oxycodone-related mortality.
Decreases in morphine use were supplanted by “marked” increases in oxycodone use, with the overall rise in opioid use being accompanied by an increase in people seeking help for dependence and an increase in overdoses, the MJA report showed.
Prescriptions for oxycodone increased linearly between 2002 and 2003 across all age groups while morphine prescriptions decreased for all age groups except those aged 50 to 59.
There were 465 oxycodone-related deaths in the eight years to 2009. While 10% of these deaths were related to oxycodone alone, 82% were due to multiple drug toxicity, with benzodiazepines and alcohol commonly implicated, the report found.
More than a quarter of oxycodone-related deaths were recorded as suicides.
“The pharmaceutical industry needs to ensure that these drugs are markmandeted to prescribers in responsible ways, and that clinical information for patients advises about the risks of using these drugs in combination with other central nervous system depressants,” two experts wrote in an accompanying editorial.
The study authors said an important implication of the increase in prescriptions was the need for increased availability of treatment options for opioid dependence.
Unlike in the US, however, the researchers found heroin was still associated with more deaths than prescription opioids, leading the editorialists to conclude that if Australia wants to avoid the “disastrous US experience with pharmaceutical opioids”, important policy changes (see box) need to be made “now”.
In a letter in the same edition of the MJA, Rheumatologist Dr Mark Awerbuch called for a mandatory signed patient-doctor agreement prior to the prescription and dispensing of opioids for chonic non-cancer pain.
“This should be sighted by the PBS authorities before such dispensing is authorised, and a copy should be held by the dispensing pharmacy,” he wrote.
MJA 195(5):280-83
Policy recommendations
National online prescription system be developed
Training and ongoing support be provided for doctors in prescribing opioids to reduce diversion
Efficacy of non-pharmacological response to pain management be investigated
GPs monitor patients’ medication use and mental health issues to minimise risk of intentional overdose among patients with chronic pain
Source: MJA 195(5):280-83