Opioid prescribing in general practice: an Australian cross-sectional survey

Abstract

Background Prescribed opioid doses > 100 mg oral morphine equivalent (OME) and/or co-prescribing of sedating psychoactive medications increase the risk of unintentional fatal overdose. We describe general practice encounters where opioids are prescribed and examine high-risk opioid prescribing. Methods The 2006–2016 BEACH study data, a rolling national cross-sectional survey of randomly selected GPs, was analysed. Results Opioid prescribing increased 2006–2007 to 2015–2016, however, this plateaued across the latter half-decade. From 2012–2016 3,897 GPs recorded 389,700 encounters and at least one opioid was prescribed at 5.2%. Opioid encounters more likely involved males, those 45–64 years, concession card holders and the socioeconomically disadvantaged. GPs more likely to prescribe opioids were 55 years or older, male, Australian graduates, and in regional and remote areas. The most common problems managed with opioids involved chronic non-cancer pain. One-in-ten opioid prescribing episodes involved high-risk doses and 11% involved co-prescription of sedating psychoactive medications. Over one-third of GPs provided other (non-pharmacological) interventions at encounters with opioid prescriptions. Conclusions Only 5% of GP encounters involved an opioid prescription. Of concern, were: prescribing for chronic non-cancer pain, potentially high-risk opioid encounters where > 100 OME daily dose was prescribed, and/or there was co-prescription of sedating psychoactive medication. However, approximately one-in-three opioid prescribing encounters involved non-pharmacological interventions.

Where we live matters: a comparison of chronic pain treatment between remote and non-remote regions of Quebec, Canada

“…Nevertheless, the results of the present study are not entirely consistent with the few available studies on the subject. According to an Australian study, general practitioners are more likely to prescribe opioids if they are practising in regional and remote regions ( 48 ). This prescribing trend in remote regions may be influenced by limited access to health services offering non-opioid treatments ( 49 ).…”

Does preoperative opioid use predict outcomes to 6 months following primary unilateral knee or hip arthroplasty for osteoarthritis? A data-linked retrospective study

“…There had been changes in regulations for dispensing opioids and policy changes made by the Royal Australasian College of General Practitioners concerning community opioid prescribing. These changes made from 2015–2018 [ 46 ] may explain the reduced levels of opioid use in 2018–2019 in SWSLHD. Another recent Australian prospective study demonstrated a prevalence of 19% of prescribed opioid use prior to hip or knee arthroplasty [ 23 ].…”

Clinical practice guideline for deprescribing opioid analgesics: summary of recommendations

“…Opioids are commonly prescribed for the management of pain, and increases in the use of prescription opioids have been observed globally over recent decades, particularly in Organisation for Economic Co‐operation and Development (OECD) countries 3 . In Australia, over 1.9 million adults initiate opioid therapies each year, 4 with the majority of prescriptions in primary care issued for maintenance therapy in chronic non‐cancer pain 5,6 . Although shown to be an effective component of the management of acute pain, opioids may not provide longer term clinically important improvements in pain or function compared with placebo or non‐opioid medications 7,8 .…”