Opioids – wonder drugs but now harder to get. Why?

Seniors experiencing chronic pain are among the biggest users of opioid medications. Now, the federal government is concerned about their over-use and has clamped down on prescriptions.

Key Points

  • Aimed at overuse and addiction, the federal government has clamped down on opioids
  • 3 million Australians experience chronic pain
  • Health practitioners to manage chronic pain without opioid reliance

Opioids are morphine-like drugs that can be made from naturally occurring opiates (eg. morphine and codeine), semi-synthetic (eg. oxycodone) and synthetic (eg. fentanyl).

The Therapeutic Goods Administration (TGA) within the Department of Health, says the change seeks to reduce the harm caused by opioid prescription medicines and ensure the safe and effective prescribing and use of opioids while maintaining access for patients who need them.

For those depending on opioids for pain relief it could mean accessing their medications will become far more difficult.

Last June, the Federal Department of Health changed the rules about how opioid medications were prescribed to tackle a rise in hospital admissions and deaths related to the drugs.

But ABC News reports Chief executive of Pain Australia Carol Bennett says the changes have serious consequences for more than 3 million Australians who experience chronic pain.

"Many people have been extremely distressed, some of them suicidal, and that's been a really awful part of this policy change," she said.

"We need to see better pain services in place and … that ideally would have happened before this policy change had been made."

Under the new regulations, opioids are only recommended for acute pain, cancer pain and palliative care.

Why the changes?

Over the past decade there has been a significant increase in the level of harm and deaths arising from the use of pharmaceutical opioids. Before the changes, every day in Australia, nearly 150 hospitalisations and 14 emergency department admissions involve issues relating to opioid use, and three people die from the harm that results.

The Health Department says opioids can be an effective component of the management of short-term and cancer-related pain. However, the evidence shows that for most people with long-term non-cancer pain, opioids do not provide clinically important improvement in pain or function compared with other treatments. Instead, they carry significant risk of harm, even when used as directed.

The regulatory changes aim to cut the number of people who start opioid treatment for short-term pain, for example following injury or surgery, and then continue to use the medicine long-term where the risk of harm outweighs benefit. The changes will also allow health professionals to implement best-practice opioid prescribing for people living with pain while ensuring adequate pain management.

For people who are gaining little benefit from opioids or who are experiencing harm, doctors are encouraged to work in partnership with their patients to safely reduce their opioid treatment over time to either stop the opioid medicine or ensure the best dose is found that effectively treats their pain while minimising the risk of side effects.

The department says many people who reduce or stop their use of opioids find that their lives improve. They can think more clearly and are more alert. Some people find their mobility is better and they are steadier on their feet. Less reliance on medication reduces trips to the pharmacy and may save money.

Can I still get prescription opioids?

If you require opioid treatment for a long period of time, for example if you have cancer or are receiving palliative care, you can receive the same opioid medications in the same way, with the same pack sizes as previously.

For short-term pain relief, medication comes in smaller pack sizes to reduce the number of opioids left over when you no longer need them. It is not uncommon for people to believe they must continue to take all of the medication in the package, even if they no longer need it.

A large number of studies have shown evidence of harm and a lack of effectiveness of long-term use of opioids for managing non-cancer pain, especially at high opioid doses.

In some conditions, non-opioid medications such as paracetamol or ibuprofen along with other types of treatment not involving medications, may provide similar pain relief as taking an opioid, without the same risk of harm. Ideally, the best alternative for a person living with long-term non-cancer pain is to enrol in a pain management program. This will explore tailored treatment that best meets the needs of each individual. Such treatment can bring in additional options that do not involve medications, including activities such as graded exercise, mindfulness, yoga, etc.

If you are concerned about the effects your opioid medication is having on you, talk to a health professional, as you may be able to gradually and safely reduce the amount of medication (known as weaning or tapering) with their assistance.

Who should I talk to about my pain management?

You should initially discuss any pain issues with your treating health professional. If you need more support, you may be referred a specialist pain clinic that offers a multi-disciplinary pain management program.

Where can I access further information about prescription opioids?

A good place to start is to talk to your doctor or nurse practitioner, who will understand your condition and the reason you have been prescribed opioids. Another good source of information is your pharmacist.

The department’s opioid resources page has links to more information for consumers, patients and carers from organisations, such as Painaustralia and NPS MedicineWise.

Sources: Therapeutic Goods Services and ABC News