Pharmacists hold focus on opioids in year of action

Maintaining focus on one of Australia’s most urgent public health crises, the latest issue of the Society of Hospital Pharmacists of Australia (SHPA)’s flagship journal is dedicated to hospital pharmacy perspectives on opioid-related harm, as the organisation prepares to implement collaborative recommendations from its landmark Reducing opioid-related harm report.

Released today – free to members – the February 2019 Journal of Pharmacy Practice and Research (JPPR) includes a special report on the 2018 publication, as well as research articles, reviews and reports on hospital discharge opioid guidelines, sustained‐release subdermal buprenorphine implants to manage opioid use disorder, and administration of oxycodone–naloxone and systemic opioid antagonism and harm.

SHPA Chief Executive Kristin Michaels says the focus on opioids is a fitting reflection of the issue’s importance to hospital pharmacists and the acutely unwell Australians in their care.

‘Through meticulous research and stakeholder consultation – including the inaugural Medicines Leadership Forum in July 2018 – we now have unprecedented insight into the post-surgery risk factors that can lead to opioid dependence in different patient populations.

‘This year SHPA looks forward to conversations with consumers, government and pharmacy, medical and nursing stakeholders to mitigate and reduce the alarming prevalence of opioid-related harm through the 33 recommendations of our November 2018 report.’

Editor-in-Chief Dr Chris Alderman places a sociological lens over the decades-long build to today’s ‘epidemic’ of opioid-related harm in the community: a result of comparatively easy access, consumer empowerment and the legacy of literature such as ‘Addiction Rare in Patients Treated with Narcotics’ published by the influential New England Journal of Medicine in 1980.

In her guest editorial, Painaustralia CEO Carol Bennett says discussion around opioids must be cognizant of the more than three million Australians affected annually by chronic pain, a ‘pervasive, complex condition’.

‘It is…indisputable that nearly all opioid prescribing has its origins in efforts to manage acute or chronic pain, yet the public discussion about how we could manage pain better and more safely is in its infancy.

‘An overreliance on opioid medications combined with a lack of access to treatment and/or knowledge of pain management is preventing Australians from getting the best possible care and most effectively reducing their pain.’

Tony Hall, Senior Lecturer and Clinical Pharmacist at the Queensland University of Technology, details nine steps all pharmacists can take to contribute to the quality use of opioid medicines, and three recommendations for responsible opioid prescribing: considering risk for abuse potential, titration with relatively small doses and changing education focus to an increase in physical functioning rather than the myth of ‘killing’ all pain.

‘There is without doubt a role for the appropriate use of opioid analgesia in modern medicine’, he says.

‘It is the realm of chronic or persistent non-cancer pain and in cancer survivors where long-term exposure to opioid analgesia may be more problematic.’

Ms Michaels says that, as medicines experts working in an acute setting, hospital pharmacists have a key role as a safeguard to reduce the risk of inappropriate medicine prescription, supply and use.

‘SHPA and our members remain committed to supporting further discussions with stakeholders, including other health practitioners and hospital managers, regarding service provision, clinical care and governance in an effort to mitigate this risk for Australian patients.’

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