Twenty‐five years of prescription opioid use in Australia: a whole‐of‐population analysis using pharmaceutical claims

Abstract

Aim The aim of this paper is to investigate 25‐year trends in community use of prescribed opioid analgesics in Australia, and to map these trends against major changes to opioid registration and subsidy. Methods We obtained dispensing data from 1990 to 2014 from two sources: dispensing claims processed under Australia's national drug subsidy programme, the Pharmaceutical Benefits Scheme, including under co‐payment records from 2012; and estimates of non‐subsidized medicine use from a survey of Australian pharmacies (until 2011). Utilization was expressed in defined daily doses (DDD)/1000 population/day. Results Opioid dispensing increased almost four‐fold between 1990 and 2014, from 4.6 to 17.4 DDD/1000 pop/day. In 1990, weak, short‐acting or orally administered opioids accounted for over 90% of utilization. Use of long‐acting opioids increased over 17‐fold between 1990 and 2000, due primarily to the subsidy of long‐acting morphine and increased use of methadone for pain management. Between 2000 and 2011, oxycodone, fentanyl, buprenorphine, tramadol and hydromorphone use increased markedly. Use of strong opioids, long‐acting and transdermal preparations also increased, largely following the subsidy of various opioids for noncancer pain. In 2011, the most dispensed opioids were codeine (41.1% of total opioid use), oxycodone (19.7%) and tramadol (16.1%); long‐acting formulations comprised approximately half, and strong opioids 40%, of opioid dispensing. Conclusions Opioid utilization in Australia is increasing, although these figures remain below levels reported in the US and Canada. The increased use of opioids was largely driven by the subsidy of long‐acting formulations and opioids for the treatment of noncancer pain.

Management of vertebral compression fracture in general practice: BEACH program

“…This could suggest that patients are remaining on strong opioids after an acute VCF and also that the need for strong opioids did not decrease over time. The increasing prevalence of opioid analgesic use in Australia has been reported in previous studies [51, 52]. The rates of opioid analgesic prescription at VCF follow-up encounters in our study support this concern.…”

Trends in adverse drug reaction‐related hospitalisations over 13 years in New South Wales, Australia

“…Over the current study period, opioids along with other pain medications, such as non‐steroidal anti‐inflammatory drugs, demonstrated an emerging trend as the leading causes of hospitalised adverse drug events. This upward trend coincides with the fourfold increase in pharmaceutical opioid use between 1990 and 2014 in Australia, as well as a two‐ to threefold increase in North America and western and central Europe . Among different types of pharmaceutical opioids, strong opioids, such as oxycodone, were commonly prescribed, which may explain some of the ADR.…”

Assessing the practice of palliative care doctors: what driving advice do they give patients with advanced disease?

“…In Australia, prescribed opioid medication use has increased substantially over the past 25 years . However, the DLA does not provide clear guidelines for patients taking opioid medications and driving.…”