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The problem with opioids Opioids are the drugs that a perfect on minute, a problem the next. How do doctors face this dilemma?
James Knox reports From a distance, Australia has seemingly avoided the opioid crisis that has spread across North America, but upon closer inspection there are parallels between what is happening in our backyard and what is reported from the other side of the world. In the past 20 years, Australia has experienced an increase in opioid use disorders and the related harms and unintentional deaths that ensues, which coincides with an upsurge in the long-term prescribing of opioids for chronic non-cancer pain (CNCP). Opioids were not always seen as the go-to treatment for CNCP, rather they were reserved for terminal cancer patients and postsurgical acute care. This changed in 1996 when the American Pain Society suggested pain was the “fifth vital sign” alongside body temperature, blood pressure, heart rate and breathing. This led the medical community to look at pain as something to be treated. At the same time, pharmaceutical companies began marketing a 22 | MARCH 2020
range of opioid analgesics to clinicians in the US as ‘safer’ alternatives to drugs such as morphine, in the context of potential patient dependency. In the early 2000s, the same opioid analgesics were classified on the Pharmaceutical Benefits Scheme (PBS) for the treatment of CNCP. The data also tells a story. Opioid prescriptions in Australia have increased fourfold since the 1990s, along with significant increases in the prevalence of opioid use disorders and unintentional druginduced deaths. Between 2016-2017, 3.1 million opioid prescriptions were dispensed in Australia. In 2018, 3 people died per day on average, due to opioid overdose, with pharmaceutical opioids present in 70% of these cases. The appropriateness of opioids is now being questioned for functional restoration of patients with CNCP – opioids block the pain without treating the source – with research suggesting non-opioid MEDICAL FORUM | PAIN MANAGEMENT ISSUE
