The country’s use of common opioids such as codeine, morphine and oxycodone is four times higher than it was a decade ago as more Australians are using the drugs to relieve the pain of cancer, HIV and other chronic illnesses, a new global study shows.
Research, published in The Lancet on Thursday, calculates that nationwide patterns of opioid analgesic use have quadrupled, with Australia’s daily dose figures increasing from 3,287 per million in 2001 to 13,440 per million in 2013.
Across the world, use of opioid painkillers has doubled over the same period, according to the research team from the International Narcotics Control Board (INCB).
The bulk of the global increase was driven by wealthy western regions like North America and Oceania – Australia and New Zealand – accounting for 95 per cent of all international opioid use.
The study’s senior author, Professor Richard Mattick from UNSW's National Drug and Alcohol Research Centre, says the heightened use of opioids in Australia is due to a rising demand for pain relief from seniors as the population ages at a magnified rate.
There are increasing rates of cancer as the ageing population increases and there’s a growing use of opioids for non-cancer pain: pain from ‘wear and tear’ as we age.
“There are increasing rates of cancer as the ageing population increases and there’s a growing use of opioids for non-cancer pain: pain from ‘wear and tear’ as we age,” says Prof Mattick.
Attitudes within the medical profession towards these medications are also improving, he says, as less doctors fear the drugs that can be addictive.
“Up until around 15 years ago, you couldn’t get these opioids unless you were in extreme pain.
“There has been an increase in willingness to prescribe these [opioids].”
Palliative care specialist and member of the Palliative Care Australia board, Associate Professor Richard Chye, agrees that more doctors and patients are learning how valuable the drugs are in managing severe pain.
“There is better recognition that pain is a real manifestation and needs to be treated,” says A/Prof Chye.
However, he contends, there is room for improvement as some doctors, patients and families still believe that all opioids are addictive in all cases.
“There is also some concern from the public that using opioids means death is approaching and they will shorten life.”
But A/Prof Chye explains that these fears are mostly unfounded. “Studies show that opioids, when used properly, provide significant benefits and improve quality of life.”
The international findings on opioid use follows an interim decision from Australia’s Therapeutic Goods Administration (TGA) to prevent codeine products, like Nurofen Plus, being made available over-the-counter for fear of misuse and dependence.
Prof Mattick says that although the matter is complex, this decision may “have negative medical consequences for individuals, especially people who are older and can’t access doctors or have to pay to see a doctor, if they have a legitimate need for pain medication and can’t get to it.”
“The consequence [of stopping codeine products being purchased over-the-counter] is reduced quality of life and increased pain in a segment of the population.
“…We don’t want to reduce the use for people who need it.
“It may be your mum or dad who gets refused opioids and tells you that they can’t take it ‘because the doctors said I can’t’. And your mum or dad actually needs pain relief.”
The international study surveyed 214 countries on opioid use.
It found the majority of low-income nations like Central America and the Caribbean, Africa, parts of Asia and Eastern Europe had little or no-access to opioid pain relief, showing with no significant increase in use in these regions over the 10 years.
The majority of low-income nations like Central America and the Caribbean, Africa, parts of Asia and Eastern Europe had little or no-access to opioid pain relief,
Prof Mattick says people in poorer countries are being denied access to opioids at a time when their cancer rates are increasing because of poor cancer screening methods.
Many doctors and patients in low and middle income countries also fear that opioid use will lead to dependence and misuse.
He adds that medical professionals in these countries also lack the training needed to fully understand the role of opioids in pain relief and cancer symptom management. International trade controls and onerous regulations also restrict opioid use.
“Our next step is to consider how do we increase access to those lower and middle income countries,” Prof Mattick says.
“We need clear data to present to governments and prescribers to indicate what the benefits and harms [of opioids] are.”
“…It will probably take a couple of decades to address but there is motivation to do this internationally.”