28 September 2010

Health professionals are reminded of the NPS resources available to them to support prescribing opioids and help patients manage chronic pain, following a provocative Four Corners program last night.

The program about oxycodone focused on several individuals’ stories of becoming addicted to prescription opioids and issues relating to doctor shopping and prescription fraud. It did not cover the positive work being done to address this issue, which NPS CEO, Dr Lynn Weekes says is disappointing.

“This program highlighted some disturbing trends in the community that relate to how people are obtaining and abusing medicines, however it did not acknowledge the programs in place to support prescribers or people addicted to pain medicines,” Dr Weekes said.

In June NPS launched a new education program, Opioid use in chronic pain: use a planned approach, which explores ways of optimising the benefits of opioids in chronic pain while minimising the harms associated with inappropriate use. These include careful patient selection, clear communication about the goals of opioid therapy, careful advice about proper use and close monitoring.

“Opioids are an option for some patients with chronic pain, with their goals being to reduce pain and to improve function and quality of life. However they should only be prescribed as part of a comprehensive pain management plan developed in consultation with the patient.”

A number of free resources have been developed as part of the program including NPS News, Prescribing Practice Review, GP clinical audit, Pharmacy Practice Review, a case study, drug use evaluation tool, counselling resources and a pain management plan and diary for patients.

“Documenting the plan and outlining the terms for opioid use can prevent unsanctioned use and provide pre-agreed approaches if the patient experiences repeated episodes of breakthrough pain. Finally, it can help patients to be realistic about the goals of their treatment,” Dr Weekes said.

Long-acting opioids are recommended for chronic pain and short-acting opioids can be used to establish pain relief requirements. However the choice of opioid, initial dose and titration schedule should be developed in line with the patient’s health, age, response and past experience with opioids. Opioids are used for the shortest period possible and preferably in combination with non-drug treatment options.

“In cases of non-specific low back pain, a thorough patient history and physical examination are critical in checking for red flag indicators of potentially serious underlying conditions. In the absence of red flags, imaging tests are not routinely recommended and are unlikely to improve patient outcomes or alter clinical decision-making,” Dr Weekes said.

For more information go to www.nps.org.au/health_professional

ENDS

Independent, evidence-based and not-for-profit, NPS enables better decisions about medicines and medical tests.We are funded by the Australian Government Department of Health and Ageing.