Prescription of opioid analgesics and related harms in Australia

Amanda Roxburgh, Raimondo Bruno, Briony Larance and Lucy Burns
Med J Aust 2011; 195 (5): 280-284. || doi: 10.5694/mja10.11450


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.



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.

  • 1. International Narcotics Control Board. Narcotic drugs: estimated world requirements for 2010. Statistics for 2008. New York: United Nations, 2009.
  • 2. Berbatis CG, Sunderland VB, Bulsara M, Lintzeris N. Trends in licit opioid use in Australia, 1984–1998: comparative analysis of international and jurisdictional data. Med J Aust 2000; 173: 524-527.
  • 3. Bell JR. Australian trends in opioid prescribing for chronic non–cancer pain, 1986 to 1996. Med J Aust 1997; 167: 26-29. <MJA full text>
  • 4. Royal Australasian College of Physicians. Prescription opioid policy: improving management of chronic non-malignant pain and prevention of problems associated with precription opioid use. Sydney: RACP, 2009.
  • 5. Cousins MJ, Brennan F, Carr DB. Pain relief: a universal human right. Pain 2004; 112: 1-4.
  • 6. World Health Organization. Cancer pain relief with a guide to opioid availability. 2nd ed. Geneva: WHO, 1996.
  • 7. Trescot AM, Helm S, Hansen H, et al. Opioids in the management of chronic non-cancer pain: an update of American Society of the Interventional Pain Physicians’ (ASIPP) Guidelines. Pain Physician 2008; 11: S5-S62.
  • 8. Kumar N. WHO Normative guidelines on pain management. Geneva: World Health Organization, 2007.
  • 9. Manchikanti L, Giordano J, Boswell MV, et al. Psychological factors as predictors of opioid abuse and illicit drug use in chronic pain patients. J Opioid Manag 2007; 3: 89-100.
  • 10. Degenhardt L, Black E, Breen C, et al. Trends in morphine prescriptions, illicit morphine use and associated harms among regular injecting drug users in Australia. Drug Alcohol Rev 2006; 25: 403-412.
  • 11. Moore TJ, Cohen MR, Furberg CD. Serious Adverse Drug Events Reported to the Food and Drug Administration, 1998–2005. Arch Intern Med 2007; 167: 1752-1759.
  • 12. Hall AJ, Logan JE, Robin L, et al. Patterns of abuse among unintentional pharmaceutical overdose fatalities. JAMA 2008; 300: 2613-2620.
  • 13. World Health Organization. The ICD-10 classification of mental and behavioural disorders — diagnostic criteria for research. Geneva: WHO, 1993.
  • 14. Drummer OH. Recent trends in narcotic deaths. Ther Drug Monit 2005; 27: 738-740.
  • 15. Strang J, Hall WD, Hickman M, Bird S. Impact of supervision of methadone consumption on deaths related to methadone overdose (1993–2008): analyses using OD4 index in England and Scotland. BMJ 2010; 341: 4851-4857.
  • 16. Degenhardt L, Roxburgh A. Accidental drug-induced deaths due to opioids in Australia, 2005. Sydney: National Drug and Alcohol Research Centre, 2007.
  • 17. Paulozzi LJ, Xi Y. Recent changes in drug poisoning mortality in the United States by urban-rural status and by drug type. Pharmacoepidemiol Drug Saf 2009; 17: 997-1005.
  • 18. Australian Institute of Health and Welfare. Alcohol and other drug treatment services in Australia 2007–08: report on the National Minimum Data Set. Canberra: AIHW, 2009. (AIHW Cat. No. HSE 73.)–detail/?id=6442468294&tab=2 (accessed Jul 2011).
  • 19. Roxburgh A, Burns L. Drug-induced deaths in Australia 2006. Sydney: National Drug and Alcohol Research Centre, University of New South Wales, 2009.
  • 20. Dhalla IA, Mamdani, MM, Sivilotti, MLA, et al. Prescribing of opioid analgesics and related mortality before and after the introduction of long-acting oxycodone. CMAJ 2009; 181: 891-896.
  • 21. Nielsen S, Bruno R, Lintzeris N, et al. Pharmaceutical opioid analgesic and heroin depdendence: how do treatment-seeking clients differ in Australia? Drug Alcohol Rev 2011; 30: 291-299.
  • 22. Kalso E, Edwards JE, Moore RA, McQuay HJ. Opioids in chronic non-cancer pain: systematic review of efficacy and safety. Pain 2004; 112: 372-380.
  • 23. Turk DC, Okifuji A. Psychological factors in chronic pain: evolution and revolution. J Consult Clin Psychol 2002; 70: 678-690.
  • 24. Frei MY, Neilson S, Dobbin MD, Tobin CL. Serious morbidity associated with misuse of over-the-counter codeine–ibuprofen analgesics: a series of 27 cases. Med J Aust 2010; 193: 294-296. <MJA full text>


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.