New Standard to Avoid Long-term Harm from Opioid Analgesics

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Every year, more than 2.5 million Australians undergo surgery in public and private hospitals, and sadly some of them become persistent users of opioid analgesics after being treated for acute pain.

A new standard of care, the first national Opioid Analgesic Stewardship in Acute Pain Clinical Care Standard, developed by the Australian Commission on Safety and Quality in Health Care, will help thousands of Australians at risk from long-term reliance on opioid analgesics following short-term use for acute pain in hospital.

The new standard sets out appropriate use of opioid analgesics in the emergency department and after surgery, and encourages doctors to consider alternate analgesics and, where opioids are required, promotes planning for their cessation.

Opioid analgesics include oxycodone, morphine, buprenorphine, hydromorphone, fentanyl, tapentadol, tramadol and codeine, which are sold under a variety of trade names. While these medicines play an important role in managing certain types of pain, they also carry potential for harm. As well as nausea, drowsiness and respiratory depression, long-term use of opioids can lead to dependence and even unintended overdose.

Conjoint Associate Professor Jennifer Stevens, Anaesthetist and Pain Management Specialist at St Vincent’s Hospitals Sydney, said there is large variation in how opioids are prescribed around Australia. She said the standard provides guidance for all patients to receive the same level of evidence-based safe and effective opioid prescribing.

“The clinical care standard encourages the use of simple analgesics such as paracetamol and anti-inflammatory medicines and non-medication techniques for mild to moderate pain. For severe acute pain, the standard recommends judicious opioid use,” said Professor Stevens.

Dr Andrew Sefton, Orthopaedic Surgeon at Dubbo Base Hospital NSW and North Shore Private Hospital Sydney, said it was important for prescribing doctors to consider how and when opioids will cease after discharge.

“It might be quick and easy to provide a repeat on an opioid prescription when we have a patient experiencing pain, but we need to reflect on the individual patient to ensure the benefit outweighs risks.

“The clinical care standard highlights the need to support transition of care into the community, with communication and plans for opioid cessation. Providing the patient’s GP with a plan outlining the expected duration of opioid use and the amount of opioids supplied is a practical way to work together,” Dr Sefton said.

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