MJA
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Prescription of opioid analgesics and related harms in Australia

Med J Aust 2011; 195 (5): 280-284. || doi: 10.5694/mja10.11450

Summary

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.

  • Amanda Roxburgh1
  • Raimondo Bruno2
  • Briony Larance1
  • Lucy Burns1

  • 1 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW.
  • 2 School of Psychology, University of Tasmania, Hobart, TAS.

Correspondence: a.roxburgh@unsw.edu.au

Acknowledgements: 

We acknowledge the Australian Institute of Health and Welfare for providing the NHMD and the AODTS-NMDS data, and the state and territory health departments for agreeing to our access to these data. We also acknowledge the Victorian Institute of Forensic Medicine for access to the NCIS. Finally, we acknowledge the Drug Utilisation Sub-Committee Secretariat, Australian Government Department of Health and Ageing for providing the prescription data. Particular thanks to Maxine Robinson and Vanna Mabbott for help and advice in calculating the daily defined doses per million for oxycodone prescriptions.

Competing interests:

Briony Larance has received untied educational grants from Reckitt Benckiser for two studies. Reckitt Benckiser has no knowledge of, or role in, the development or writing of this article.

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