Prescription of opioid analgesics and related harms in Australia
Roxburgh, A and Bruno, R and Larance, B and Burns, L, Prescription of opioid analgesics and related harms in Australia, Medical Journal of Australia, 195, (5) pp. 280-284. ISSN 0025-729X (2011) [Refereed Article]
Objective: To document trends in: (i) prescribing of morphine and oxycodone;
(ii) hospital separations for overdose; (iii) presentations for treatment of
problems associated with these drugs; and (iv) oxycodone-related mortality
data in Australia.
Design and setting: Cross-sectional study analysing prescriptions for morphine
and oxycodone based on figures adjusted using Australian Bureau of Statistics
estimated resident population and prospectively collected data from: (i) the
National Hospital Morbidity Database on hospital separations primarily
attributed to poisoning with opioids other than heroin ("other opioids"); (ii) the
Alcohol and Other Drug Treatment National Minimum Data Set for treatment
episodes where morphine or oxycodone were the primary or other drugs of
concern; (iii) the National Coronial Information System on deaths where
oxycodone was the underlying cause of death or a contributory factor.
Main outcome measures: Population-adjusted numbers of (i) prescriptions for
morphine and oxycodone by 10-year age group, (ii) hospital separations for
"other opioid" poisoning, and (iii) treatment episodes related to morphine or
oxycodone; and (iv) number of oxycodone-related deaths.
Results: Prescriptions for morphine declined, while those for oxycodone
increased. Prescriptions for both were highest among older Australians. Hospital
separations for "other opioid" poisoning doubled between the financial years
2005–06 and 2006–07. Treatment episodes for morphine remained stable,
while those for oxycodone increased. There were 465 oxycodone-related deaths
recorded during 2001–2009.
Conclusions: Oxycodone prescriptions in Australia have increased, particularly
among older Australians. The increase may, in part, reflect appropriate
prescribing for pain among an ageing population. However we are unable to
differentiate non-medical use from appropriate prescribing from this data. In
comparison to heroin, the morbidity and mortality associated with oxycodone is
relatively low in Australia. There is a continued need for comprehensive training
of general practitioners in assessing patients with chronic non-malignant pain
and prescribing of opioids for these patients, to minimise the potential for harms
associated with use of these medications.