Thursday, January 24, 2013

Opiophobia Alive & Well in Oz

In the NewsWith all the recent ruckus over prescription opioids and sensational news headlines in the American press inciting fears of these medications, it is easy to believe that the United States is the only country facing such challenges. Apparently, the news is even worse from “down under” in Australia.

According to a brief news item — by Renee Viellaris and appearing in The Australian on January 19, 2013 [here] — physicians will “begin weaning some patients off pain medication as the nation's insatiable habit of pill popping has left health and law enforcement agencies buckling under pressure.” New pharmaceutical guidelines, to be presented this year to state and federal health ministers, will disallow prescribing some patients with “highly addictive and popular pain pills.”

The news report claims that the move has been prompted by the financial drain on the federally-funded Pharmaceutical Benefits Scheme (PBS) from excessive analgesic prescribing, misuse of the medicines, and “research showing long-term use of opioids is counterproductive.” Based on 2010 figures from the Australian National Centre for Education and Training on Addiction (NCETA), in that single year demand for subsidized prescriptions for two types of popular analgesics — oxycodone and fentanyl — cost taxpayers an extra $18 million [$18.9 million USD].

Dr. Steve Hambleton, federal president of the Australian Medical Association, confirmed that “some patients with noncancer pain would have to be weaned off the drugs because they were too expensive and were no longer clinically appropriate. Patients with long-term back or hip pain and those with sporting injuries who take the popular drugs face being directed to alternative therapies, including yoga.”

Hambleton called for more money from government to set up chronic pain clinics in hospitals, but conceded that the new regulations will dramatically change how pain is treated, and at a time when policy makers are also coping with an ageing population. “Some patients will have to be weaned off (and will have to do) things like physical therapy and focus on what you can do and not what you can't — more of a positive attitude,” he said in the news article.

The news report concludes that, “Research provided by NCETA shows that the per capita amount of morphine-equivalent drugs Australians are taking has exploded in the past 30 years.” Furthermore, “the number of Queenslanders on opioid dependence programs is dramatically increasing.”

COMMENTARY: The news report, brief as it is, tells a grim story of what may lie ahead for patients with chronic pain in Oz. And, unfortunately, this is not unlike what is occurring or may happen in other parts of the world, including the U.S.

Our quick scan of the websites of Australian organizations — Chronic Pain Australia serving patients/advocates, and the Australian Pain Society serving healthcare professionals — found no mention of these dire developments. Among other concerns, it would be interesting to know of what research evidence authorities are examining that proves the long-term use of opioid analgesics is “counterproductive.”

The news article notes that the number of persons in Queensland entering opioid-dependence treatment programs has been “dramatically increasing.” However, an accompanying chart shows the rise was only 19% — from roughly 4,900 to 5,800 persons — during the 5-year span 2008 to 2012. It does not say what proportion was attributable to prescription opioid abuse/addiction, or whether this was actually a favorable trend suggesting that more persons with substance-use problems are seeking and getting much needed care. [The U.S. CDC had presented some time ago similarly puzzling data on treatment-program admissions, discussed in an UPDATE here.]

Saving money on federally-funded prescription plans may seem like a worthwhile goal, but we wonder if authorities have considered the unintended consequences — financial and otherwise — of leaving large populations adrift to suffer chronic pain. It seems rather cavalier to suggest that these patients should adopt more positive attitudes and participate in alternative therapies, like yoga, since such interventions only work if they can get out of bed and move nimbly about without adequate pain-relieving medication.

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