Opioids down on PBS but private scripts rising

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Prescribed use went down overall, but much was offset by an increase in private prescriptions.


Subsidised opioid prescriptions are declining in Australia, but some of that fall is made up by rises in private dispensing and hospital use.

PBS and sales data from 2015-22 shows total prescribed opioid analgesic use decreased by 3.4% per year.

While PBS claims for opioids decreased by 6% per year, private scripts and public hospital use went up by nearly 7% per year.

“Effectively, a quarter (26.2%) of the decrease in PBS dispensing claims observed from 2015 to 2022 was offset by an increase in private dispensings/public hospital use,” write the authors of the research, published in the International Journal of Drug Policy.

Where private prescriptions and public hospital use previously made up 14% of all opioid dispensing, this nearly doubled, climbing to 27%.

Hospitals overall accounted for 8-10% of opioid use and declined 1% per year.

A large part of the overall reduction was due to declining prescriptions of controlled release (CR) formulations, which are associated with higher risk of dependence than immediate release (IR) formulations, of oxycodone, oxycodone + naloxone (since 2018), tramadol, fentanyl and morphine. Total use of IR formulations increased from 2015-2018 by 4.6% – mainly due to uptake of tapentadol IR, which is not on the PBS – and decreased by 2.6% from 2018-22.

Tapentadol IR and CR is currently the most commonly prescribed opioid in Australia (27% of all sales).

“The contribution of private market/public hospital opioid use to total prescribed opioid analgesic use was highest for IR formulations and increased from 21.3 % to 48.6 % between 2015 and 2022. This has implications for research on opioid use using PBS claims data, with the potential for significant under-capture of IR formulations in more recent years,” the authors wrote.

Australia was ranked eighth highest in per-capita opioid consumption prior to measures implemented in 2017. Opioid-related hospitalisations subsequently from 8909 in 2015-16 to 6568 in 2020-21 and deaths went from 5.8 per 100,000 people in 2017 to around four per 100,000 people in 2021, with 56% of opioid deaths in 2022 attributable to opioids other than heroin.

The data included figures for all single-ingredient and combination formulations of prescription-only opioid medicines used for pain relief (buprenorphine, codeine (>15mg strengths and linctus), dextropropoxyphene, fentanyl, hydromorphone, methadone, morphine, oxycodone, pethidine, tapentadol, tramadol and methadone and buprenorphine formulations not used to treat dependence).

Covid may have affected the trends seen, especially since surgeries were delayed and that could have led to an increase in opioid use and dosage, the authors point out.

International Journal of Drug Policy, 6 December 2024

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