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Five reasons to not prescribe opioids

Lynn M Weekes
Med J Aust 2015; 203 (5): 206. || doi: 10.5694/mja15.00737
Published online: 7 September 2015

Around one in five Australians experience chronic pain. This is a complex condition to manage, with varied aetiology, pathology and presentation. Multimodal strategies are key, using a combination of different treatment modes to address the biological, social and psychological factors that contribute to the development of chronic pain.

Non-pharmacological strategies are an essential part of management. Medicines have a limited role in managing chronic pain, with guidelines recommending them only as an adjunct to non-pharmacological options. However, despite a lack of evidence to support long-term efficacy, the number of prescriptions for opioids continues to rise in Australia.

There are five key reasons not to prescribe opioids, and to consider deprescribing at every visit.

Adverse events

There is an increased risk of adverse events with extended opioid use: around 80% of people taking opioids long term will experience an adverse event. Most common are constipation, nausea and somnolence, but more serious adverse events can occur.

Limited evidence

Opioids have a limited role in chronic pain management because of a lack of evidence for their long-term benefit.

Central sensitisation

Central sensitisation and tolerance can occur within 4 weeks, limiting the viability of opioids as a clinical intervention.

Risk of abuse

There is a risk of abuse, misuse and addiction. People using opioids long term can develop an opioid-use disorder or exhibit drug-seeking behaviour.

Comorbidities

Co-existing conditions complicate management with opioids: major depression is the most common, and psychotropic medicines can interact with opioids to cause excessive sedation and respiratory depression.

The latest education program from NPS MedicineWise focuses on management of chronic non-cancer pain and is designed to help health professionals consolidate their knowledge on chronic pain management. The program is underpinned by evidence, current guidelines and best practice, and attracts continuing professional development points. To access the program, visit http://www.nps.org.au/chronic-pain.

  • Lynn M Weekes

  • NPS MedicineWise, Sydney, NSW

Correspondence: lweekes@nps.org.au

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access_time 09:49, 7 September 2015
Diarmuid McCoy

There are many problems with opioids and the main ones are outlined here. Many of these problems can be managed. The problem with persistent pain is significant; opioids do offer a role albeit a minor one. Opioids appropriately used in correct doses and well selected patient groups are an excellent addition to the OVERALL management of patients with pain. We use some very dangerous drugs such as warfarin and steroids but with thoughtful consideration these are useful, indeed life saving. It is in the considered approach in some patients that opioids can be and are used effectively.

Competing Interests: No relevant disclosures

Dr Diarmuid McCoy
Barwon Health

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