The opioid epidemic: do we need to rethink pain?
A landmark report has highlighted the link between opioid prescriptions in hospital and the long-term risk of dependence, prompting calls for more collaboration and conversation around pain management.
Released by the Society of Hospital Pharmacists of Australia (SHPA), the report found that more than 70% of hospitals frequently supplied opioids for patients to take home “just in case”, even when they have not required them in the 48 hours prior to discharge.
The paper also noted that pharmacists reported extremely high use of sustained-release opioids in the treatment of acute pain for opioid-naive surgical patients.
Based on data from 135 Australian facilities, the report outlined 33 recommendations to enhance local strategies to improve patient care nationwide.
Opioid prescription in hospitals now routine, increasing risk of dependence
Professor Michael Dooley, president of the SHPA, told doctorportal that the unnecessary use of opioids was particularly pronounced among surgical patients.
“They may come in for knee, hip and other procedures, and they’re in quick and smart. We’re trying to flow them through and they just get written up for a script of 20 Endone, just as routine.”
“The patients may not have needed anything over the last day or two, but we still tend to write them up for a packet of opioids, and they grab them and leave the hospital.”
He said that while the prescription of opioids as a precaution is well intended, there are proven dangers with this.
“There is clear evidence that giving patients opioids to take home, when they don’t need them, puts them at risk of continuing to take them.”
“This can then precipitate some pretty traumatic and tragic paths of dependence.”
Not all pain needs to be eliminated
Professor Dooley described current perceptions of pain as being caught in a pendulum. “We have probably swung too far in thinking that all pain is bad pain, and that we need to eliminate all pain.”
“We need to treat serious pain, but with mild pain, often patients will tolerate it. We actually don’t have a magic bullet for minor pain – it’s probably something that people can cope with.”
“If someone has done in their knee or ankle, the pain is telling them not to stand on it or to push themselves too hard.”
Professor Dooley said Australia’s current relationship with opioids stands in contrast to how it began.
“About 15-20 years ago, we had morphine, and everyone was really concerned about opioids and how to use them. Then we got oxycodone, and now we’ve got 130 opioids and people have become less aware of the potential downstream implications.”
Starting meaningful conversations about opioids is essential
Professor Dooley said that having conversations around opioids was the most important step to take in addressing the problem.
“We need to start having conversations with patients and tell them about their pain and analgesia.”
Professor Dooley added that patients need to be empowered to ask key questions around whether pain medication is needed, how long they should take it, and how long they can reasonably expect their pain to last.
“At the moment, no one really has that conversation with patients. As with all these things, there needs to be multiple people having those conversations with the patient, repeating the same message.”
He said that doctors, pharmacists and nurses all need to be involved in this. “For example, often nurses will approach a patient and ask them if they would like a painkiller, rather than asking how their pain is going, and if they are okay with that level of pain.”