Study shines light on oxycodone prescribing habits

Michelle Wisbey

9/04/2024 4:38:24 PM

Regional patients are most likely to be first-time users, with a study warning GPs to use ‘careful assessment’ when prescribing.

Zoomed in blister pack.
New users of oxycodone were an average of 54.7 years old and 52.5% were female.

New research has, for the first time, painted a picture of Australia’s typical oxycodone user in a bid to better understand the link between opioid use and sociodemographic factors.
Published in the British Journal of Clinical Pharmacology, the University of New South Wales research said previously, little was known about oxycodone usage in Australia, why it is used, and the settings in which it is prescribed.
This is despite oxycodone being the most prescribed opioid in Australia, accounting for 38% of opioid prescriptions in general practice.
Using the data of more than 800,000 New South Wales residents prescribed the opioid between 2014–18, the study found new users of oxycodone were an average of 54.7 years old and 52.5% were female.
Half of new oxycodone initiations followed an episode of acute care or a therapeutic procedure in the previous five days, while the other half was initiated by a GP or specialist for other reasons.
Of those, 4.6% were still on treatment 12 months later.
Oxycodone was most commonly prescribed following discharge from hospital, in the wake of a recent therapeutic procedure, or after a visit to an emergency department.
It also revealed oxycodone use among people living in areas outside the major cities was significantly elevated, but said this could not be explained by age, sex, or socioeconomic disadvantage.
‘These findings imply that interventions in acute care settings could have a substantial impact on the proportion of the population exposed to opioids,’ the study said.
‘Long-needed efforts to improve the quality use of oxycodone and other opioids in rural and regional areas will require a closer examination of the reasons for this disparity.’
Procedures including joint or hip replacement surgery, caesarean section, and other surgeries accounted for about one half of all new oxycodone use.
New oxycodone usage in women aged 18–44 was significantly higher than for men of equal age, highlighting the contribution of opioid initiation after delivery by caesarean section.
The research comes amid new Australian hospital care standards which require GPs to be provided a patient’s opioid weaning and cessation plan upon their discharge.
‘General practitioners should be competent with multimodal approaches to analgesia and should be ready to escalate care to specialist services including pain management, drug and alcohol, clinical pharmacy and allied health as required,’ the research states.
‘However, the recommended care escalation options for general practitioners and their patients may be limited and difficult to access in many settings.’
Lead author Dr Malcolm Gillies hopes the knowledge will help inform interventions to improve prescribing practices and the quality use of medicines.
‘Even after a serious operation we would expect the need for oxycodone to relieve pain would be over by 90 days,’ he said.
‘The fact that a proportion of people were taking oxycodone 12 months later underlines the need for early, careful assessment of ongoing pain to maximise appropriate use of non-opioid and non-pharmacological pain control.’
The Medication Assisted Treatment for Opioid Dependence (MATOD) program is a CPD approved activity, offering participants recognition as an authorised prescriber for medication-assisted treatment for opioid dependence.
More information on its modules, eligibility, and how to apply is available on the RACGP website.

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