Tasmanian Opioid Review
The Department of Health and Human Services has reviewed opioid prescribing in Tasmania investigating issues surrounding Tasmanian prescribing of drugs of dependence.
The review covered:
1. How medical specialists support/approach the issue of opioid use and how this influences GPs prescribing of opioids and other aspects of treatment and care, particularly in the area of chronic pain management including the need for better education and support.
2. The often associated adverse outcomes of long-term use of opioids where there has not been a comprehensive assessment of benefits, risks and harms arising from treatment with opioid medications. This includes issues with drug dependent patients requiring opioid treatment either for dependence or pain or both.
3. The regulatory aspects of opioid use and prescribing including the role of the Pharmaceutical Services Branch (PSB), which is responsible for the legislation relating to the possession, prescribing and supply of opioids through the Tasmanian Poisons Act and Regulations. PSB is responsible for the monitoring of the prescribing and supply of all opioids and as part of this role issues authorisations to prescribers to prescribe opioids for more than two months.
A catalyst for the review was Tasmania’s per capita consumption of morphine over recent years has been up to 36 per cent higher than the national average. Tasmania has a well-recognised issue with the diversion of legally prescribed opioids to recreational use. Most opioids sold have been legitimately prescribed. There is very little heroin in Tasmania.
Deaths in Tasmania associated with opioid abuse, misuse or lifestyle factors around their use/misuse are significant.
The review delivered recommendations for change as well as looking at best practice approaches in both pain and addiction medicine. It compared prescribing levels in Tasmania with those in other jurisdictions, as well as international prescribing levels.
The review has resulted in a major report 'A review of Opioid Prescribing in Tasmania - A blueprint for the future’ that will shape the approaches (clinical, regulatory, educational and epidemiologically) to the use of opioids in the management of chronic pain and other evidence-informed approaches.
A process has been developed to respond to the recommendations in collaboration with responsible bodies.
The focus of the review and its recommendations is on supporting quality use of medicines and on avoiding harm from the misuse of opioids.
The wide-ranging recommendations need to be carefully assessed to determine a suitable response. DHHS will take a leadership role for their implementation. This is important given some of the recommendations involve health providers and regulatory issues that come under the auspices of the Poisons Act.
Implementation also involves DHHS bringing together and supporting a reference group of stakeholder organisations, including medical groups, the university, clinical pain management services, regulators and government to whom the recommendations are relevant.
Solving the issues around opioid use is a long-term effort and the work of the review is a significant milestone as it represents a major cornerstone of evidence and expert input for future directions.
The review was undertaken by the National Drug and Alcohol Research Council based at the UNSW. The main reviewers were Professor Richard Mattick and Dr Fiona Shand.