The Royal Australian College of General Practitioners (RACGP) has welcomed changes introduced to help reduce the harms associated with prescription opioids as part of a suite of measures to reduce opioid-related harm.
Under changes to the Pharmaceutical Benefits Scheme (PBS) concerning opioid prescribing that came into effect this week, opioid medications will now be only available in smaller packs with no repeats for the treatment of non-chronic pain. Patients with long-term chronic pain will still be able to access larger pack sizes and repeats when certain requirements are met.
The changes are in response to concerns regarding the high number of deaths and hospitalisations due to prescription opioids. There is increased recognition that opioids are a poor choice for most types of pain.
It comes as the RACGP encourages Australians to consult with their GP if they have concerns about their use of opioids or other drugs, including alcohol. The College recently launched an online education program for GPs to further enhance their skills in caring for patients with alcohol and other drug issues, including prescription opioid dependence or misuse.
GPs across Australia are reporting that the COVID-19 pandemic has led to a noticeable increase in patients presenting with problematic substance use.
Chair of the RACGP’s Expert Committee on Quality Care Professor Mark Morgan has welcomed the PBS changes.
Opioids can cause dependence
“The changes to the PBS listings will make a difference. GPs know they need to be cautious when prescribing opioids and to carefully monitor a patient’s use of these drugs. Opioids have important therapeutic uses but they can cause dependence, lead to risky use and cause harm.
“Opioid dependency can affect people from all walks of life. For example, a person may present with a painful back injury resulting from a workplace accident or sporting mishap and be prescribed opioids, only to find it difficult to wean themselves off the drug after prolonged use.”
Chair of the RACGP Addiction Medicine network Dr Hester Wilson also welcomed the new changes but said that more must be done to combat harm resulting from opioids.
“Limiting quantities and repeats is only one step towards reducing the harms that can result from opioids,” Dr Wilson said.
Black market alternatives
“Unfortunately, I fear some people who have their opioid prescriptions limited will find it hard to give up and some may turn to black market alternatives.
“We need to be alert to that and government must ensure that there are enough treatment services available in as many locations as possible because substance use affects all communities.
“I also think that we need to be much more proactive in helping patients with alcohol and other drug problems, including prescription drugs and illicit drugs.
“For example, we need to do more to get naloxone, a drug that can temporarily reverse an opioid overdose, into the hands of people who need it most – that includes people at risk of overdose and their loved ones.”
Dr Wilson says naloxone saves lives but not enough people know about it.
An intranasal spray version is now available meaning you don’t have to inject it.
“It is likely that some GPs may know about the drug but not of the availability of the intranasal spray and how easy it is to use,” Dr Wilson says.
Weaning people off opioid drugs
“Expanding access to opioid pharmacotherapy options such as methadone and buprenorphine is also really important. This can prove decisive in weaning people off opioid drugs. But again, there is the factor of cost and some health professionals not having much knowledge or awareness of how beneficial this form of treatment can be.”
Dr Wilson says there is a stigma surrounding alcohol and other drug treatment and management and this needs to change.
Problematic opioid use can affect anyone, he says.
“The RACGP’s education program for GPs is important and it couldn’t have come at a better time given what GPs have been seeing since the pandemic hit. What we need is for GPs to continue to have honest conversations with their patients about alcohol and other drug use and do all they can to help them.
“That may mean patients being referred on to specialist treatment, agreeing to a mental health plan, or discussing with their GP about how to cut down on substance use and improve health and wellbeing.
“So I urge all patients to please reach out to your GP if you have concerns about your drinking or drug use, including opioids.”
Don’t neglect your health
Dr Wilson says GPs are not there to judge, but to help you.
Now more than ever, substance use needs to be treated seriously, he adds.
“The COVID-19 pandemic has been a very difficult time for many people. Some have lost their jobs or are worried about losing their jobs, some are anxious about contracting the virus themselves or a loved one contracting the virus.
“There has of course been increased social isolation with people not being able to see their friends and family as often. Even just disruptions to usual routines like exercise and trips to the shops can have a massive impact on someone’s mental health.
“So once again I say to all patients – your GP is there for you. Don’t neglect your health during this pandemic and that includes help for alcohol and drug use.”
The stresses caused by this pandemic can result in people increasing their alcohol and drug intake to self-medicate, Dr Wilson says.
Supporting patients through a difficult time
If that is the case your GP is there for you to help and remember you can take advantage of telephone and telehealth consults if you don’t want to visit the clinic in person.
“I am concerned that this pandemic will see a ‘second wave’ of health challenges including mental health concerns and suicides. A substantial component of fighting that is helping people with alcohol and other drug issues.
“GPs are ideally positioned to support patients with their drinking and other drug use during this difficult time.”
In April the RACGP launched an Expert Advice Matters Campaign urging patients to take care of their health and see their GP for any health issues.
It followed widespread reports that patients are avoiding important medical consultations and tests because they fear COVID-19 and either don’t know about or feel uncomfortable with telephone or online consultations.