The findings are ‘encouraging’, according to one expert.
Fewer Australians are being started on tapentadol which aligns with efforts to reduce inappropriate opioid use, experts say.
New findings from researchers based at the University of Sydney, published in the International Medicine Journal, suggest publicly subsidised tapentadol initiation rates have declined in recent years, and that most patients prescribed the drug only use it for a short period of time.
PBS dispensing and private sales data showed tapentadol sales had increased rapidly over the last decade since the opioid received TGA approval and was listed for PBS subsidy. While supposedly safer than stronger options such as morphine and oxycodone, concerns surrounding the risk of dependence and overdose still existed.
This latest study provides information about the specific trends in tapentadol initiation rates and individual usage patterns.
Professor Suzanne Nielsen, deputy director of the Monash Addiction Research Centre in Melbourne, told The Medical Republic it was critical to keep a close eye on tapentadol trends.
“It’s important we understand how tapentadol use and outcomes are changing given it’s one of the newer opioids on the market and that we’ve seen quite a large increase in its use,” she said.
Researchers used longitudinal dispensing records from a 10% random sample of PBS-eligible Australians and national tapentadol sales data to explore trends surrounding the use of subsidised tapentadol in Australia.
Tapentadol initiation rates increased from 0.8/1000 people in 2014 to a peak of 7.5/1000 in 2019, before falling to 5.3/1000 in 2021. The researchers suggested the covid pandemic and changes to opioid prescribing policies and regulations were responsible for the decline in tapentadol initiations.
The changes to opioid prescribing and regulations, introduced in June 2020, included changes in the pack sizes of opioids used for acute pain, a tightening of indications for opioids and the need for a second opinion if opioids are to be continued for more than 12 months.
While the majority of tapentadol sold in Australia has been subsidised by the PBS, there was a 6% drop in PBS-attributable tapentadol dispensations per month from June 2020 onwards and a corresponding increase in private sales.
Many factors contributed to the decline in publicly subsidised tapentadol dispensations, according to Professor Nielsen.
“The smaller pack sizes would have been one driver, and the price point would have been another,” she said.
“If there wasn’t an enormous difference between having it dispensed privately compared to the PBS, it would make sense that someone who was potentially seeking a larger quantity might move towards private prescriptions.”
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More than 90% of the 60,000 new tapentadol users discontinued publicly subsidised tapentadol use within 12 months, with approximately 60% receiving just one dispensing.
Professor Nielsen said these findings were consistent with what we know about opioid prescribing more broadly.
“Most people will only have opioids for a very short period. There has been a lot of focus around not continuing opioids for longer than needed, especially after surgery, and it’s encouraging that we’re seeing this in the dispensing data,” she told TMR.
One in four patients were also dispensed a gabapentinoid within 30 days of receiving tapentadol, while one in five patients were dispensed a benzodiazepine during the same period. Approximately half of the new tapentadol users had received another PBS-listed opioid in the 90 days before receiving their first dispensation of tapentadol.
Sustained release tapentadol (ranging from 50 mg to 250 mg tablets) received TGA approval in February 2013 and has been subsidised by the PBS since June 2014. Immediate release tapentadol is only available through private prescription.
