Monash research reveals extent of strong and high-dose opioid pain medication use

More than one in 13 Australians who start using weak opioid pain medications transition to stronger opioids, according to new research by the Centre for Medicine Use and Safety (CMUS) at the Monash Institute of Pharmaceutical Sciences.

Popular weak opioid pain medications include codeine, tramadol and tapentadol, while stronger opioids include morphine, fentanyl and oxycodone.

Published in leading journal Addiction, CMUS research fellow and Monash Health pharmacist Dr Samanta Lalic analysed opioid dispensing data from Australia’s Pharmaceutical Benefits Scheme (PBS) from July 2013 to January 2018.

The research found that more than 26,000 Australian adults who start using low doses of opioids each year will escalate to higher doses.

Director of CMUS, Professor Simon Bell, said: “This research is the first of its kind to reveal the number of Australians who transition from weak to strong opioids, or escalate from lower to higher doses.”

There were 679 overdose deaths involving opioid pain medications in Australia in 2016, and the majority of these deaths were unintentional. There is concern that harm from opioid pain medications in Australia may mimic the situation in the United States and Canada, where the problem has been labelled an epidemic.

“High-dose opioid use has been linked with increased falls, fractures, hospitalisation, motor vehicle accidents, overdose and death,” Dr Lalic said.

The research also discovered that older people, males and people treated for cancer, transition or escalate more rapidly to strong and high-dose opioids than others.

“Our findings help identify groups of people who are at risk of transitioning to stronger or higher doses of opioids. This knowledge is important for planning strategies to better anticipate and manage potential harms when opioid pain medications are initiated,” she said.

“While the decision to escalate the dose or switch to a stronger opioid should be carefully considered, higher doses and stronger opioids are not always inappropriate. It is also important to ensure appropriate management plans exist for people already taking high-dose or stronger opioids.”

The findings highlight the importance of evaluating local, state and national policy initiatives to determine the most effective strategies to mitigate the risk of opioid related harm.