New research is paving the way to effectively reducing opioid prescribing, but experts caution that improved communication with patients and striking a balance for those who do benefit from opioids is crucial.

Professor Michael Farrell, Director of the National Drug and Alcohol Research Centre, told HealthTimes that “we do need to be careful”.

“We have a large population of ageing people with significant pain and while the strong opioids cause a whole host of complications, for some people, life is intolerable without them – so it is a real question of getting the balance right.”

“Without a doubt, in the United States, the balance is completely out. In Australia, there’s a clear push around the capacity to manage pain with lifestyle, physiotherapy and other non-medication approaches, and that’s critically important.”

“At the same time, we can't lose sight of the fact that these medications are very good for acute pain. It’s just when you go onto opioids chronically, you develop other problems, and they don't do the job they were originally doing for the acute
pain.”

Professor Farrell was commenting on new research which evaluated whether small group education sessions with junior doctors and pharmacists would reduce analgesia prescribing for surgery patients.

The study found this education approach, which tailored information and case studies to different specialties, was effective in reducing prescribing of opioids at discharge.

Lead researcher and Research Fellow at Monash University’s Centre for Medicine Use and Safety, Ria Hopkins, said there had been much commentary around opioid use that has been “harsh” on doctors and healthcare providers.

“In the past, they’ve almost been blamed for the problems we have with opioids”, she told HealthTimes.

“But I think at the end of the day, healthcare providers and doctors just want to help their patients, and it's very hard when patients are in pain – they want to provide that relief.”

Ms Hopkins added, however, that communicating with patients about the way opioid prescribing has changed is not something that has been done well to date. 

“Increasing regulations around opioids, and big changes to codeine scheduling and opioid prescribing on the PBS – I don't think those discussions are always happening with patients.”

“We are doing some qualitative research at the moment, and one of the things we're hearing is that patients are just being told by doctors ‘oh, I'm not allowed to prescribe that to you anymore’. There’s no deeper discussion really happening.”

Ms Hopkins said that with growing media coverage of this issue, there is an increasing awareness in the community about opioids – including the harms associated with taking them.

“It all needs to start with good communication and partnerships between doctors and patients. Even when I talk to people, they tell me that if there are alternatives to opioids that their doctor would discuss with them, they’d be willing to give it a
try, but it’s just about whether or not that discussion is even taking place.”

Associate Professor Suzanne Nielsen, Deputy Director of the Monash Addiction Research Centre, told HealthTimes that it must be emphasised that no patient should feel that their opioids are being “taken away”.

“One of the most important messages for patients on opioids, and the healthcare professionals they are working with, is that in the cases where any benefits from opioids do not outweigh the harm for that individual patient, a collaborative plan to
trial reducing off opioids with support should be developed.”

“We know that the outcomes from forced tapers and abrupt opioid cessation are not good and this should be avoided, and the patient should be a part of these decisions for the best outcomes.”

Professor Farrell said that obtaining full and informed consent between patient and doctor before starting these medications must be a priority.

“At the start, some people say they were never told that opioids could cause problems. It needs to be documented that it’s been made clear that [opioids] should only be used for a short period of time and that there are consequences for taking
them longer.”

Ms Hopkins added that society’s attitude towards pain and the term “painkiller” has also been problematic in setting up unrealistic expectations around pain.

“One of the things we introduced in the education sessions [in our study] was talking about realistic expectations for pain management, particularly after surgery or when there’s been a traumatic injury, because expecting a level of 0 pain here is
unrealistic.”

“Something we spoke to doctors about was moving away from looking at pain as a number from 1 to 10, and looking at it in terms of function. Particularly as it is so subjective - my 6 out of 10 pain is going to be different to your 6 out of 10.”

Associate Professor Nielsen said there has been a shift away from using the term “painkillers” for this reason.

“In addition, we now know that many patients do not require opioids, or require much lower amounts than were typically prescribed ‘just in case’.”

“There are a number of good quality studies showing that discharge quantities of opioids can be reduced after surgery with no impact on pain at the patient level”, Associate Professor Nielsen said.

“Of course, opioids when needed are critical for acute pain, it is more about tailoring both expectations, and discharge quantities so we are not suppling excess opioids that are left in medicine cabinets and contribute to non-medical use and
overdose.”

Professor Farrell agreed, saying that giving patients discharge opioids, which then continue to be used, is a pattern that needs to be stamped out

“We need to have a much higher standard around pain management though, and non-medication pain management.”

“The great thing about this study, is that it’s actually about simply translating [what we know] into practice. It’s an example showing that when you do some training, you can see a change in behaviour”, he said.