Medication can influence your patient’s recovery, health and wellbeing. If you and your patient believe opioids are a suitable option, ensure the treatment is tailored to their personal needs. In monitoring their wellbeing and side effects, you can maximise patient benefits and minimise the potential harms.

There has been a marked increase in the use of prescription opioids for the treatment of chronic non-cancer pain (also known as persistent pain). This is despite growing evidence challenging the effectiveness of their use in these circumstances and even identifying the risk of adverse effects and potential for dependence.

With over 1.98 million Australian adults starting prescription opioids each year,¹ and over 3.1 million given an opioid yearly,² it’s important for all health professionals to know the role of prescriptions opioids and the negative impacts they can have.

The Impact Of Opioids On A Patient’s Wellbeing

80% of people who take opioids for three or more months will experience an adverse side effect.³ These effects can impact all body systems and include:

  • Central nervous system: drowsiness, depression, hyperalgesia, changes in cognitive function
  • Dermatological system: itchiness
  • Gastrointestinal systems: ±50% will experience constipation, ±25% will experience nausea, fluid retention
  • Musculoskeletal: increased risk of bone fractures (88% increase in total risk)
  • Immune System: decreased effectiveness of natural and acquired immunity
  • Endocrine System: decreased sexual function, loss of muscle, anxiety /depression
  • Respiratory and Sleep Systems: respiratory depression, central and/or obstructive sleep apnoea

Research has also identified the indirect harms associated with prescription opioids – initiating an opioid more than doubles the risk of a patient aged over 65 sustaining a hip fracture, and taking an opioid increases the odds of road trauma by up to 42%.

All of these side effects can greatly impact a person’s day-to-day function and put their lives at risk.

How Common Are Opioids In South Australia?

Opioids are a common pharmaceutical in South Australia. The Playford region in metropolitan Adelaide has the second highest opioid dispensing rate of any statistical area in Australia – over 109,191 dispensed prescriptions for opioid medication per 100,000 persons. In our country, areas dispensing rates of over 86,000 per 100,000 include Barossa, Gawler–Two Wells and South East SA.

This data supports the claim that opioid use is higher in areas with:

  • a greater proportion of people in jobs requiring physical labour
  • higher unemployment
  • a greater proportion of men
  • a greater proportion of people aged over 65 years
  • more low-income households

Opioids And Surgery

Research is identifying the significant negative impact the regular use of opioids pre-surgery can have on surgical outcomes, including an association with increased post-operative complications.¹⁰ Reducing the use of opioids before surgery can result in improved clinical outcomes for your patients, comparable to those who use no opioids at all.¹¹

The role of opioids in post-surgery management is a focus in Australia. Recent research has identified in many Australian hospitals prescription opioids are a standard discharge prescription post-surgery.¹² A report from the Society of Hospital Pharmacists of Australia (SHPA) identified more than 70% of hospitals frequently supplied opioids for patients to take home “just in case”, even when they have not required them in the 48 hours prior to discharge.¹³ In April 2019, the Lancet revealed a major contributor to the opioid issue is the inappropriate management of post-surgery pain that becomes chronic and long-lasting.¹⁴

It’s important to discuss post-surgical pain whilst setting and managing your patient’s expectations.

For more information, explore the work being undertaken by Dr Jennifer Stevens, anaesthetist and pain specialist at St Vincent’s public and private hospitals in Sydney and acting chair of ScriptWise.

Unwanted Medications

To assist in avoiding diversion, encourage your patients to return medications they no longer need. For a free and convenient option, visit your local pharmacy and ask about the Return Unwanted Medicines (or The RUM Project).

 

[1] Lalic S, et al. (2018), ‘Prevalence and incidence of prescription opioid analgesic use in Australia’ in British Journal of Clinical Pharmacology, 85:202-215.

[2] Dobbin MD (2014), ‘Pharmaceutical drug misuse in Australia’ in Australian Prescriber, 37(3): 79-81.

[3] NPS MedicineWise (2019), Chronic Pain.

[4] Nicholas R (2019), Pharmaceutical opioids in Australia: A double-edged sword, National Centre for Education and Training on Addiction (NCETA), Flinders University.

[5] Veteran’s Medicine Advice and Therapeutics Education Services (2018), Medicines: the hidden contributor to falls and hip fractures.

[6] Nicholas R (2019), NCETA: Flinders University, Pharmaceutical opioids in Australia: A double-edged sword, National Centre for Education and Training on Addiction.

[7] Roche A, et al. (2018), NCETA: Flinders University, Patterns and prevalence of alcohol and other drug use in rural Australia.

[8] Roche A, et al. (2018), NCETA: Flinders University, Patterns and prevalence of alcohol and other drug use in rural Australia.

[9] Nicholas R (2019), NCETA: Flinders University, Pharmaceutical opioids in Australia: A double-edged sword, National Centre for Education and Training on Addiction.

[10] Cozowicz C, et al. (2017), ‘Opioid prescription levels and postoperative outcomes in orthopaedic surgery’ in Pain 158(12): 2422-2430.

[11] Nguyen LCL, et al. (2016), ‘Preoperative reduction of opioid use before total joint arthroscopy’ in Journal of Arthroplasty 31(9): 282-287.

[12] The Society of Hospital Pharmacists of Australia (2018), Reducing opioid-related harm: a hospital pharmacy landscape paper.

[13] The Society of Hospital Pharmacists of Australia (2018), Reducing opioid-related harm: a hospital pharmacy landscape paper.

[14] Monash University (2019), ‘Landmark Lancet series reveals poor management of surgery pain key contributor to global opioid crisis’.