Doctors over prescribing opioids

opioid over prescription

When it comes to prescription drug addiction, doctor shoppers are not the whole story ...

Australians are two-and-a-half times more likely to die from an overdose of an opioid prescribed by a doctor, or stolen from a hospital, than from a hit of illegally imported heroin bought on the street.

Opioids are now more widely available in little bottles with child proof caps, or in mass produced lozenges and patches, than in unmarked zip-lock plastic bags.

But this is not due solely to doctor shoppers gulling naive doctors. As Central Coast GP Dr Paul Muthiah wrote recently in Australian Doctor, “blaming the conniving doctor shopper doesn’t wholly address the issue”.

Firstly, Australian doctors are prescribing opioids like never before. Since 2009, Australia has seen a massive general increase in opioid prescriptions – rising from 10 million to 14 million annually.

Secondly, the majority of people overdosing on prescription drugs are not the stereotypical doctor shopper. In seven out of 10 prescription drug overdose cases examined by the Victorian Coroners Court, for example, the deceased had only seen just one GP.

Given this context, Dr Muthiah has a fairly blunt message for his colleagues in the medical profession: “What I am talking about is our failure as GPs to address our role in the crisis and alter our prescribing choices”.

Speaking late last year, the Executive Officer of the Victorian Alcohol and Drug Association Sam Biondo told the ABC that opioid addiction can be difficult to identify and treat, especially in patients who don’t fit the doctor shopper stereotype. He also argued that “sloppy prescribing practices” have contributed to Australia’s increasing rates of prescription drug addiction.

Some observers have put this down to “indication creep”: the increasing use of opioids in the management of chronic non-cancer pain.

Despite the fact that, according to the Medical Journal of Australia, “there is limited evidence of the long term efficacy of opioids for chronic non-cancer pain”, some doctors continue to prescribe them in just such cases.

An added layer of complexity arises from the expectations of patients. Nowadays many patients assume they will walk away from a doctor’s appointment with a script for a pharmaceutical fix to their problem.

Earlier this year the Therapeutic Goods Administration (TGA) issued a discussion paper on the use and misuse of strong prescription opioids. Among other things, the discussion paper aimed to “increase health care professional awareness of alternatives to opioids in the management of chronic pain”.

In its submission to the TGA, the Australian Rheumatology Association (ARA) proposed general practitioners should have restrictions placed on their ability to prescribe higher dose Schedule 8 opioids.

The ARA argued that this would help to break a growing trend among those GPs who are inappropriately prescribing these medicines to patients with treatable diseases.

To view the MJA article go to:
https://www.mja.com.au/journal/2016/204/8/using-opioids-general-practice-chronic-non-cancer-pain-overview-current-evidence

For the ABC article see:
http://www.abc.net.au/news/2017-11-21/doctor-shoppers-not-at-heart-of-prescription-opioid-crisis/9167606

To view the submissions to the TGA see:
https://www.tga.gov.au/submissions-received-prescription-strong-schedule-8-opioid-use-and-misuse-australia-options-regulatory-response