Guidelines for Doctors in the use of Opioids for Pain Relief

Today’s announcement by the Australian Commission on Safety and Quality in Health Care (ACSQHC) setting out guidelines for doctors in the appropriate use of opioids in the Emergency Department and post surgery is welcomed by anyone at the coal face of managing an ever-increasing opioid addiction, a global medical challenge that is costing economies billions of dollars a year.

In Australia, there are more than 3.4m people suffering daily from chronic pain, many of whom have been prescribed opioids to help them manage mundane tasks most of us take for granted. Chronic pain is an annual $139.3billion burden on the Australian economy in costs associated with lost workdays and healthcare.

Each year in Australia, patient mishandling of prescribed opioids and the illegal use of opioids such as heroin causes more than 2,200 deaths and 32,000 hospital admissions.

So while we support the new standard introduced today by the ACSQHC and any other regulatory reforms, the difficulty lies in how doctors manage their patients who develop chronic pain after an accident or operation without opioids. Not prescribing opioids in the first place is one solution but funding is desperately needed to continue research and education in how to assist patients who experience long-term chronic pain.

There is a plethora of other issues that arise in chronic pain sufferers such as depression and anxiety, all of which adds to the economic, social and medical impacts so regulations need to be accompanied by education and information provided to doctors to help them implement new pathways to assist their patients.

In 2018, the Therapeutic Goods Administration introduced reforms to minimise harm and limit inappropriate prescribing and in June 2020, further changes were made to the PBS but 1 in 5 Australians still suffer from long-term chronic pain and 10% of these patients will develop an addiction to opioids. The number of Australians who will suffer from chronic pain is predicted to rise to 5.23 million by 2050.

An ongoing research project by the Pain Management Research Institute (PMRI), located at Royal North Shore Hospital campus and supported by the not-for-profit Pain Foundation Ltd, is developing and evaluating a screening tool to potentially identify patients admitted to Emergency Department and post-surgery who may transition from acute pain to chronic pain, defined as pain that continues after three months or after it should have subsided. If successful, this study will allow doctors to identify patients who may develop chronic pain in advance and intervene with a treatment plan to prevent such an occurrence.

Another PMRI research project, aimed at patients who are being deprescribed opioids, is studying the management of chronic pain via technology. One of the studies currently underway with the potential to greatly assist chronic pain sufferers in remote areas without access to pain clinics, is the effectiveness of regular supportive text messages in a similar way that is used for tobacco dependence.

But like most medical research projects, project funding is imperative as we seek effective ways to help the millions of Australians who have very little quality of life and who regard opioids as their only answer.

*Pain Foundation helps provide funding to the researchers and clinicians at the Pain Management Research Institute.

AN END TO PAIN?
To find out more or to help research into understanding pain please contact Louise at the Pain Foundation on email media@painfoundation.org.au.

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