UNSW Sydney researchers at the National Drug and Alcohol Research Centre and the Medicines Intelligence Centre of Research Excellence have found the proportion of hospital visits where people started opioids and remained on them long-term was small and declined over the six years to 2020.
“Australia has looked on with concern at the widespread harm from prescription opioid painkillers in the US,” said pharmacist and epidemiologist Kendal Chidwick, lead author of the study, which has been published in the British Journal of Clinical Pharmacology.
“While these medicines are an important tool for reducing moderate to severe pain in the short-term, they have significant side effects.
“Our analysis suggests that efforts to reduce opioid use in Australia have been successful, in terms of post-hospital use.”
The researchers followed all hospitalisations and emergency department (ED) visits in NSW between 2014 and 2020, focusing on people who had not used prescription opioids in the year before.
Long-term use was defined as 90 or more days of continuous opioid use at some time during the period between 90 to 270 days after initiation.
“Previous research suggests that about half of all prescription opioids are started after a hospital or ED visit,” said study co-author Dr Malcolm Gillies, who is a biostatistician from the Medicines Intelligence Research Program at UNSW. “That can go on to long-term use.”
Australia has deployed a range of measures to reduce opioid use and related harms. Measures have included smaller pack sizes, restricting repeat dispensing, and changing low-dose codeine to prescription-only, alongside real-time prescription monitoring and increasing implementation of opioid stewardship programs in hospitals.
“It appears that the tide has changed in Australia, with reductions in opioid use after hospital admissions,” said Dr Gillies.
“Our study revealed that both starting an opioid after a hospital or ED visit, and remaining on it long-term, declined over time, which is good news.”
From 2014 to 2020, overall opioid initiations decreased by 16 per cent, from 8.7 per cent to 7.2 per cent of hospital and ED admissions, and long-term opioid use decreased by 33 per cent, from 1.3 per cent to 0.8 per cent.
“Ensuring that each patient has their pain effectively managed while minimising harms is key when it comes to opioid prescribing,” said Dr Gillies.
“Looking at the bigger picture, best-practice care of chronic pain will mean increasing access to coordinated multidisciplinary pain services.”
The study also found that one in four people admitted for trauma, such as a physical injury or road accident, started an opioid and 2.3 per cent of them went on to long-term use.
One in 15 people attending ED started an opioid, and 1 per cent of them went on to long-term use. This is lower than estimates from the US.
“It’s reassuring to have evidence, at the population level, that Australia’s rates of long-term prescription opioid use following hospital and ED visits are low compared to some other countries,” said Ms Chidwick.
“Our results highlight variation by patient demographic and admission characteristics. Continued opioid stewardship is critical to ensuring the balance of benefits and harms.”
