Opioid pack changes ‘long overdue’, but more reform needed

New restrictions, announced by Federal Health Minister Greg Hunt, will also be placed on the use of fentanyl patches that limit their clinical use to cancer care, palliative care or other exceptional circumstances.
 
However, GP and addiction medicine specialist Dr Paul Grinzi told newsGP that, while the changes are ‘long overdue’, more reform is needed.
 
‘Opioid use disorder and the factors contributing to it are complex, and it would be too simplistic to think these measures alone will have any significant impact on this condition,’ he said.
 
‘They will help but, to be honest, optimising the grossly underfunded pain and addiction sectors, along with social health policy, is what we desperately need.’
 
Of the announced reforms, Dr Grinzi believes clearer labelling is important, but that reduced package sizes will have the greatest impact.
 
‘When one considers the first-line indications for opioids, acute and severe post-surgical or post-traumatic pain, and contrasts this with the most commonly prescribed indications, chronic non-cancer-related pain, reduced packet sizes will assist with aligning opioids with their primary indication,’ he said. 
 
‘There will be some pushback, but I hope [reduced package sizes] will trigger some reflection on the less convincing role of ongoing opioids in chronic pain management going forward.’
 
Dr Grinzi said clearer labelling should also help patients and families understand the gravity of adverse opioid effects, and hopefully reinforce clinical discussions provided by GPs and pharmacists.
 
‘I’d like this change to go further, with a morphine equivalence for non-morphine products clearly visible on the packaging,’ he said.
 
‘Many GPs I speak to are surprised to find a high-risk morphine equivalence for their oxycodone and fentanyl prescribing because the absolute dose seems smaller than its morphine-equivalence.’
 
The changes correlate with recommendations found in a Society of Hospital Pharmacists of Australia (SHPA) report, aimed at reducing the risk of opioid dependency or misuse for people self-managing pain after leaving hospital.
 
Minister Hunt announced the upcoming reforms at the SHPA 2019 Medicines Leadership Forum, and SHPA chief executive Kristin Michaels said she was pleased the Government had adopted some of the society’s recommendations.
 
‘The challenge is clear, with 650,000 medicine-related care episodes in hospitals – comprising 250,000 medicine-related hospital admissions and 400,000 potentially medicine-related presentations to emergency departments – each year in Australia,’ she said.
 
‘In this complex area, communication is key and we welcome moves toward clearer information on opioid labelling relating to the risk of long-term use and overdose, as well as more comprehensible Consumer Medicines Information leaflets.
 
‘Fentanyl patches have been singled out as a significant factor in the United States’ ongoing opioid crisis and we strongly welcome moves to limit their clinical use in Australia to cancer care, palliative care and/or exceptional circumstances.’
 
Dr Grinzi said any moves to reduce the amount of fentanyl, the most potent commonly prescribed opioid in Australia, should be supported.
 
‘It is disproportionately involved in unintended overdoses in Australia,’ he said.
 
‘It’s also commonly prescribed in the elderly, who are most susceptible to adverse effects such as increased falls risk and cognitive impairment … [and] increasingly involved in the illicit drug market.’

addiction medication safety opioids Therapeutic Goods Administration