Caution repeated on dispensing of strong opioids

20 Dec 2017 | Health Quality Intelligence

The Health Quality & Safety Commission has updated information on the use of opioids for 2016 in its Atlas of Healthcare Variation.

Its latest summary information for the opioids Atlas domain again recommends that health practitioners considering prescribing opioids for chronic non-malignant pain carefully undertake a benefit-to-harm evaluation to ensure that opioid therapy is the best option. 

Dr Alan Davis, chair of the Commission’s opioid expert advisory group says while opioids are highly effective in managing certain types of pain, they can also cause patient harm.

“This might include nausea, constipation, delirium, hypotension, addiction or even potentially life-threatening over-sedation and respiratory depression.

“Strong opioids are very effective at managing pain – but evidence shows the longer they are used, the less effective they are”.

In recent years the number of people in the community given a more potent opioid at least once in a year has gone up, from 63,000 people in 2011 to 77,000 people in 2016.

In 2016, strong opioid use increased significantly with each age group, with 11 percent of those aged 80 and over dispensed a strong opioid in a year.

Nationally 16.7 per 1000 people received a strong opioid, with most receiving morphine (11.2 per 1000). On average 1.8 per 1000 people received fentanyl.

The variation between DHBs in fentanyl use continues to increase. This is driven by an increase in the use of fentanyl in some DHBs.

Further analysis has been done comparing rates of use of three strong opioids  – morphine, fentanyl and oxycodone – for those aged 65 and over living in the community and those living in a rest home.

The analysis shows that morphine and fentanyl use increased faster in 2016 for those living in a rest home than for those living in the community and this has been flagged as an area for further investigation.

Data for the opioids atlas domain is drawn from the Pharmaceutical Collection, which contains claim and payment information for subsidised dispensing from community pharmacies. This collection does not allow for analysis of patients’ condition or the effectiveness of the dose provided, meaning it was not possible to assess the appropriateness or otherwise of prescribing.

Further reading

Opioid rain: opioid prescribing is growing and practice is diverging (NZMJ 19 August 2016)

Last updated 21/12/2017