The safety and value of reducing opioid use are recognised, but difficult conversations and less accessible alternatives are barriers
Chronic pain affects about 20% of adults in Australia and New Zealand,1,2 and opioids have been enthusiastically embraced for treating it. Unfortunately, this has led to significant harm,3,4,5 and evidence of the long term effectiveness of opioids for relieving chronic pain is limited.3,6
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- 2. New Zealand Ministry of Health. New Zealand Health Survey: annual data explorer 2019/20. Adults/topic: other health conditions. Nov 2020. https://minhealthnz.shinyapps.io/nz-health-survey-2019-20-annual-data-explorer/_w_15f47ab5/#!/explore-topics (viewed Feb 2021).
- 3. Chou R, Turner JA, Devine EB, et al. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health pathways to prevention workshop. Ann Intern Med 2015; 162: 276–286.
- 4. Shipton EE, Shipton AJ, Williman JA, Shipton EA. Deaths from opioid overdosing: implications of coroners’ inquest reports 2008–2012 and annual rise in opioid prescription rates: a population-based cohort study. Pain Ther 2017; 6: 203–215.
- 5. Australian Institute of Health and Welfare. Opioid harm in Australia and comparisons between Australia and Canada. (AIHW Cat. no. HSE 210). Canberra: AIHW, 2018. https://www.aihw.gov.au/getmedia/605a6cf8-6e53-488e-ac6e-925e9086df33/aihw-hse-210.pdf.aspx?inline=true (viewed Feb 2021).
- 6. Krebs EE, Gravely A, Nugent S, et al. Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: the space randomized clinical trial. JAMA 2018; 319: 872–882.
- 7. Tardif H, Hayes C, Allingham SF. Opioid cessation is associated with reduced pain and improved function in people attending specialist chronic pain services. Med J Aust 2021; 214: 430–432.
- 8. Matthias MS, Johnson NL, Shields CG, et al. “I’m not gonna pull the rug out from under you”: patient-provider communication about opioid tapering. J Pain 2017; 18: 1365–1373.
- 9. Webster F, Rice K, Katz J, et al. An ethnography of chronic pain management in primary care: the social organization of physicians’ work in the midst of the opioid crisis. PLoS One 2019; 14: e0215148.
- 10. Matthias MS, Krebs EE, Collins LA, et al. “I’m not abusing or anything”: patient–physician communication about opioid treatment in chronic pain. Patient Educ Couns 2013; 93: 197–202.
- 11. Prathivadi P, Barton C, Mazza D. Qualitative insights into the opioid prescribing practices of Australian GP. Fam Pract 2020; 37: 412–417.
- 12. Dunn E. Breaking the pain barrier. Medical Observer [online], 1 June 2018. https://www.apsoc.org.au/PDF/Other_Pain_Resources/20180601_Medical_Observer_Breaking-Pain-Barrier_JUN18.pdf (viewed Mar 2021).
- 13. Australian Department of Health. Chronic disease management: allied health individual services. Updated 10 Apr 2014. https://www1.health.gov.au/internet/main/publishing.nsf/Content/Chronic+Disease+Allied+Health+Individual+Services (viewed Mar 2021).
- 14. Bennett C. The impact of pain on rural and regional Australia: problems and solutions [abstract]. National Rural Health Conference, Hobart, Tasmania, 24–27 March 2019. https://www.ruralhealth.org.au/15nrhc/sites/default/files/B2-1_Bennett.pdf (viewed Mar 2021).
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I have no connections with the tobacco, alcohol or gaming industries. I have received funding for consultancies or for serving on expert advisory panels from Indivior, Lundbeck, Seqirus, Mundipharma, and Pfizer.