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T he tension that exists around the prescription of opioids has been highlighted by Painaustralia CEO Carol Bennett. Ms Bennett tells Retail Pharmacy Assistants it’s not the reforms that are problematic, which in fact are necessary in many instances given the level of harm, but rather the interpretation of them by health practitioners who may decide that a rapid reduction is warranted, causing more harm. The opioid codeine was available over the counter until being restricted to prescription-only in 2018 because of the ever-increasing rates of harm and death related to its use as an OTC product. This upscheduling, strongly supported by Painaustralia, was followed by the TGA implementing more stringent opioid controls, including restricting the use of fentanyl patches to patients with cancer in palliative care or under “exceptional circumstances” in August 2019. Painaustralia also supports the latest round of reforms, aimed at the most harmful use of opioids, Ms Bennett says. “Our concern is more about the impact of the reform agenda if it doesn’t go hand in hand with consumer and health professional awareness, as well as the availability of support and services to replace opioid treatments,” she said. Ms Bennett emphasises that not all opioids affect people in the same way, with differences apparent between efficacy, adverse effects and toxicity as well as risk of dependence. “There’s no evidence that atypical opioids are more effective – yet,” she said. “Individuals respond differently to different medications, including different types and strengths of opioids. The evidence is still not clear that certain types of opioids, such as atypical opioids, are more effective, have fewer adverse effects and reduce toxicity. More definitive research would be required to prove this.” Better pain management awareness, she adds, could help avoid some negative consequences of opioid use for chronic pain conditions, keeping in mind that, overall, opioids play a much smaller role in the management of chronic non-cancer pain than they do in severe acute pain and cancer pain. “Regardless of differences, there’s a general feeling that we’ve gone too far in the direction of opioid regulation, and this has consequences for people in pain, from injuries to post-surgery acute pain, who are missing out when it comes to pain management,” Ms Bennett said. “There’s also a group of people in chronic pain who’ve been on opioids for a long time and who’ve been suddenly told they must come off them, in some instances in a tapered way, which should happen, and in some instances in an abrupt way, which can be traumatic.” Ms Bennett says she believes the regulations are appropriate in targeting use of high-strength medications such PAIN MANAGEMENT 31 as fentanyl, and that it’s also appropriate for governments to carefully consider smaller pack sizes for people leaving hospital who aren’t opioid dependent. Overall, she stresses, it’s not the regulations that are inappropriate, but rather the “overreach” response from some health professionals when restrictions are applied to specific medications. “It can become a knee-jerk reaction where a health professional becomes so concerned with their role as a drug prescriber that when they encounter restrictions or regulations they pull back or feel they need to be more cautious, without really being sure of the reasons why or how to manage pain per se,” Ms Bennett said. “So, it’s not about the appropriateness of the regulations, but more about the responses to the regulations and what support services are available in the instances where people don’t get appropriate pain management. Those are the issues.” The cost of pain The Deloitte Access Economics report, ‘The cost of pain in Australia’, launched by Health Minister Greg Hunt last year, highlighted many key findings, such as: • 3.24 million Australians lived with chronic pain in 2018 (53.8 per cent women and 68.3 per cent of working age). • Pain restricts the activities that most (56 per cent) Australians can undertake. TO PAGE 32 Now available behind the counter Effective relief from persistent pain associated with Osteoarthritis AvailabTloe ptolaocredearnvoiardaellrmtajlokrtwohyooleusraSlearlse,syoRuerpSrealseesnRteaptirveseonrtactailvle1o3r0c0al9l 1A3R00RO9WARROW INCORRECT USE COULD BE HARMFUL. ASK YOUwRwPwH.AcRhMemACisItSsTo–wTnH.cEoYmM.UauST DECIDE IF THIS PRODUCT IS RIGHT FOR YOU. RETAIL PHARMACY ASSISTANTS • JUN 2020