Landmark report reveals urgent collaboration needed to stem looming opioid ‘epidemic’
The first Australian study to comprehensively analyse current hospital pharmacy practices around opioids has shone a light on the link between the prescribing and supply of opioids to patients after surgery in public and private hospitals nationally and heightened risk of long-term misuse and dependence, highlighting the urgent need for a coordinated, multidisciplinary response.
Released today by Society of Hospital Pharmacists of Australia (SHPA) President Professor Michael Dooley, Reducing opioid-related harm: A hospital pharmacy landscape paper exposes national inconsistencies in provision of pharmacy services to reduce risk of opioid misuse, extremely high use of sustained release opioids and poor handover of discharge information for use by General Practitioners.
Professor Dooley says by beginning an important conversation about services in hospitals, SHPA seeks to collaborate with other healthcare practitioners and organisations to prevent unnecessary harm caused by opioids initiated in the hospital setting.
‘This work highlights that current practices in hospitals relating to the prescribing and dispensing of opioids at discharge are resulting in quantities in excess of patient need, which has the potential to lead to preventable harm.
‘We found clinical pharmacy services are often unable to prioritise surgical patients being discharged and these patients are not having an appropriate review of their medication.
‘Consequently, as identified in this report, more than 70% of hospitals frequently supplied opioids for patients to take home “just in case”, even when they have not required them in the 48 hours prior to discharge.
‘Also of significant concern, pharmacists reported extremely high use of sustained-release opioids in the treatment of acute pain for opioid-naive surgical patients.’
Professor Dooley says despite a promising start, implementation of opioid stewardship programs is insufficient and disparate across Australia.
‘Our findings reveal less than 5% of hospitals have formal opioid stewardship programs, which are showing good progress in reducing unnecessary opioid supply, and even fewer have invested in other innovative responses to address this growing problem.’
The report, informed by data from 135 metropolitan, regional and rural Australian facilities, identifies 33 recommendations to scale up proven local strategies to improve patient care nationwide, as relevant to pharmacy, medical and nursing, consumer and government stakeholder groups.
Professor Dooley says the judicious use of opioids is important in the treatment of pain and recovery from surgery.
‘In 2016-17 there were more than 2.2 million surgeries in public and private hospitals following which the prescribing and supply of opioids is commonplace.
‘Currently, provision of opioid de-escalation plans at discharge are rare, with less than 10% of respondents providing these – hospital pharmacists have a role to play in supporting patients to use medicines when needed and to reduce their risk of harm through involvement in discharge planning and the provision of cognitive clinical services for patients at the bedside.
‘This insight gathered by SHPA members adds enormous impetus to consolidate and expand efforts already underway to reduce opioid harms in six key areas: working with prescribers, engaging patients, supporting opioid stewardship, managing medication supply, supporting transitions of care between the hospital and the home and empowering pharmacists as medicines experts.’
The report comes days after researchers from Monash University’s Centre for Medicine Use and Safety published findings showing the ‘opioid epidemic has reached Australia’, revealing almost two million Australian adults begin taking prescription opioids every year, with thousands becoming long-term users. Earlier this month, data from the Australian Institute of Health and Welfare revealed deaths involving opioids have nearly doubled in the last ten years in Australia, with pharmaceutical opioids accounting for more drug-related deaths in Australia than any other drug category.
SHPA Chief Executive Kristin Michaels says with more and more Australians taking opioids and risking misuse or long-term dependence than ever before, the time to act is now.
‘As demand for surgery continues to grow, the importance of pain management and the prescribing and supply of medicines for surgical patients when discharged from hospital also increases.
‘SHPA members are key members of multidisciplinary teams in hospitals across Australia, and we are proud of their commitment to respond to this public health challenge. We look forward to working closely with other stakeholders from medical, nursing and allied health fields to collaborate on this important issue in 2019.’
- 'The opioid epidemic: do we need to rethink pain?', Doctor Portal, 28 November 2018.
- 'Hospitals regularly prescribe opioids on discharge 'just in case', Pharmacy News, 28 November 2018.
- 'They're not lollies': pharmacists urge rethink on opioids, Sydney Morning Herald, 26 November 2018.
- 'SHPA opioid epidemic alert', Pharmacy Daily, 26 November 2018.