Regulatory and other responses to the pharmaceutical opioid problem

Campbell, Gabrielle; Lintzeris, Nicholas; Gisev, Natasa; Larance, Briony; Pearson, Sallie; Degenhardt, Louisa

doi:10.5694/mja2.12047

Topics

Pharmaceutical preparations

Substance‐related disorders

Anesthesia, analgesia and pain

How is Australia responding to the trends in pharmaceutical opioid utilisation and opioid harms?

In the past 20 years, there have been substantial increases in the use of pharmaceutical opioids in many countries including Australia, which has one of the highest levels of opioid utilisation globally.1 Almost 15 million opioid prescriptions were dispensed in 2015 and our use of high potency opioids has also increased.2 One of the main drivers is the higher use of prescription opioids for chronic non‐cancer pain (CNCP).3 In parallel to escalating use, opioid‐related harms have also increased. Since 2000, there has been a shift in hospitalisations due to opioid poisonings and opioid‐related deaths from predominantly heroin to pharmaceutical opioids.4 Extramedical use — defined as any use of a medication outside the formal medical system or inconsistent with a doctor's prescription5 — is also relatively common; the most recent household survey indicates that “non‐medical use” was reported by 4.8% of the Australian population.4

1 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
2 University of Sydney, Sydney, NSW
3 Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW
4 University of Wollongong, Wollongong, NSW
5 Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW
6 Menzies Centre for Health Policy, University of Sydney, Sydney, NSW

Correspondence: G.Campbell@unsw.edu.au

Acknowledgements:

Gabrielle Campbell, Natasa Gisev, Briony Larance and Louisa Degenhardt are supported by National Health and Medical Research Council fellowships (No. 1119992, 1091878, 1073858, and 1135991). The National Drug and Alcohol Research Centre at the University of New South Wales is supported by funding from the Australian Government under the Substance Misuse Prevention and Service Improvements Grant Fund.

Competing interests:

Some of the authors have received investigator‐initiated untied educational grants from Reckitt Benckiser and Indivior for studies of buprenorphine–naloxone (Briony Larance, Louisa Degenhardt and Nicholas Lintzeris), buprenorphine depot (Briony Larance, Louisa Degenhardt and Nicholas Lintzeris), naloxone (Louisa Degenhardt), the development of an opioid‐related behaviour scale (Briony Larance, Louisa Degenhardt and Nicholas Lintzeris), projects regarding opioid dependence treatment (Nicholas Lintzeris), and a study of opioid substitution therapy uptake among patients with CNCP (Briony Larance, Louisa Degenhardt, Gabrielle Campbell and Nicholas Lintzeris). Louisa Degenhardt and Briony Larance have also received an untied educational grant from Seqirus for studies of tapentadol. None of these are directly relevant to the current manuscript.

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