What Australia should do about prescription opioid misuse

Knowing the dose of the tablet means overdoses are less common than with heroin. d ab d z/Flickr

Consumption of slow-release prescription opioids has been increasing in Australia for about two decades. Now, the federal government has said it will set up a new $5 million national electronic records system to improve monitoring of these drugs.

The Electronic Recording and Reporting of Controlled Drugs system will be made available to doctors, pharmacists and state and territory health authorities across Australia to monitor the prescribing and dispensing of addictive drugs in real time.

Before the government moved toward national implementation, this system was tried out in Tasmania and evaluated favourably.

Consumption trends

Consumption of these drugs began earlier and increased faster in the United States. Overdose deaths from prescription opioids there first outnumbered such deaths from heroin and cocaine in 2000. That gap has steadily widened in the past ten years. And more and more people in the United States struggling with dependence on prescription opioids have been coming forward to seek help.

So we know the pattern of what would happen in Australia if we allowed consumption of prescription opioids to keep increasing. Canada and the United Kingdom have also reported similar developments to Australia.

Road to problems

Doctors prescribe opioids to treat pain from cancer, acute pain (such as after an operation or heart attack) and chronic pain not due to cancer. They’re usually very effective for the first two sorts of conditions but nowhere near as effective for the latter.

In Australia, prescriptions for opioids are obtained by a relatively small number of people who visit a large number of doctors to obtain huge quantities of these drugs. Profits from selling the drugs on the black market are very high because people who enjoy taking opioids for recreational purposes have found heroin a little harder to purchase since a heroin shortage started in Australia in 2000.

Another contributing factor to the increasing use is the growing difficulty in recent years of getting on to methadone and buprenorphine programs. There are no votes in funding these forms of treatment, even though 70% of the community now support them.

So, many heroin users have started buying prescription opioids from the black market, crushing these tablets and injecting them. Overdoses are less common than with heroin because, unlike street heroin, the dose of the drug in tablets is known.

Effective interventions

Australian health authorities have known all this for a while. But it’s a complex problem that crosses commonwealth, state and territory governments. And within each department of health, several sections have to be involved.

There’s no silver bullet but a number of strategies will help, especially if some leadership is applied to the problem. Unfortunately, leadership is a scarce commodity in Australia’s current volatile political climate, with attempts at major health-care reform taking up a lot of time.

And we are now moving to a national real-time, web-based data system for prescriptions. That will help, but efforts to stem the supply of drugs in the face of strong demand, while politically irresistible, often promise more than they end up delivering.

Important steps

Improving the treatment of chronic non-cancer pain will have to be part of the solution.

Most of this treatment is provided by general practitioners. While Australia has a surfeit of excellent guidelines for treating chronic non-cancer pain, none are written by general practitioners for general practitioners.

We also need a whole system for training allied health professionals to help manage chronic non-cancer pain with non-pharmacological treatments. But there’s no training course, no qualification and no way of funding this at present. So general practitioners will continue to prescribe large quantities of prescription opioids while treating chronic non-cancer pain.

Other options

Expanding methadone and buprenorphine treatment and making these more affordable to drug users, who generally have low-incomes, would also make the black market for prescription opioids less lucrative.

We need to develop a new treatment system for people struggling with dependence from prescription opioids. While there’s some overlap with the population using heroin, some of the people who develop problems with prescription drugs are quite different from heroin users.

A national policy for prescription opioids and benzodiazepines is now being prepared and this is a positive step since Australia has never had a policy covering these drugs. It seems ironic that these legal drugs have been ignored for so long. Many of the people who enjoy taking prescription opioids and heroin recreationally also take benzodiazepines.

Path least travel

In the alcohol and drug field, the politics of implementing effective responses are generally much more complex than working out the right public health interventions. And the cost of politically attractive policies that don’t work is getting harder to bear in an era when government budgets are stretched to breaking point.

The lesson of Australia’s heroin epidemic of the 1990s was that politicians must start getting serious when increasing numbers of deaths begin occurring among middle-class kids.

This effort by the Federal government to create a national electronic record system for prescription opioids is a step in the right direction. But unless it is supported by a range of other measures, there is a risk that it will send us backwards. Supply measures are easy to sell to the public but are often disappointing and sometimes seriously counter productive.