Tamper-resistant oxycodone tablets have not made a dent in Australia’s dangerous dependence on prescription opioids, a major study shows.
The findings are a stark reminder that injecting users are not the main game when it comes to combating Australia’s burgeoning opioid misuse. Pain and drug experts say inappropriate prescribing is at the heart of Australia’s addiction to the painkillers.
The tamper-resistant formulations were introduced in Australia in April 2014 in response to growing concerns people were crushing and dissolving the tablets to snort or inject the potent opioid.
The tablets contain a polymer, making them hard and plastic-like, as well as a hydrogelling agent. The tablets can’t be crushed into a fine powder, and rather than dissolving in water, they form a thick gel.
Tamper-resistant oxycodone has had no effect on the rates of opioid use, admissions to hospital and overdoses at a population level, found the five-year National Opioid Medication Abuse Deterrent (NOMAD) study published on Thursday in The New England Journal of Medicine.
The NOMAD study found people who injected drugs were less likely to tamper with the deterrent tablets and did not appear to switch to other opioids, such as heroin.
But the tamper-resistant tablets did not slow the unrelenting rise in opioid misuse in Australia, and there was no change in the rates of opioid-related harm including hospital admissions, emergency department presentations or ambulance call-outs for overdoses. Data on fatal overdoses was not available.
There had been no drop in the sales of higher-strength controlled-release oxycodone and an increase in lower-strength formulations at a population level since the new formulations were introduced, reported the authors, led by researchers at the National Drug and Alcohol Research Centre.
The most thorough evaluation on the issue to date analysed Australian opioid sales and health datasets, annual surveys of people who inject drugs, and a cohort of more than 600 people who reported tampering with opioids in NSW, South Australia and Tasmania before and after the introduction of the tamper-resistant tablets.
Briony Larance is the lead author of an international study. Photo: Nick Moir
The findings were unsurprising to opioid misuse experts, considering most opioid users take them orally and don’t have a history of drug use.
While the tamper-resistant oxycodone did have significant impact among the group of people who inject drugs, who are exposed to significant opioid-related harm, this group accounted for a “tiny minority” of Australia’s opioid-using population, lead author and NDARC researcher Briony Larance said.
An estimated 93,000 people injected drugs in Australia in 2014, compared with 2.9 million who were prescribed an opioid.
About 20,000 doses are prescribed for every 1 million people in Australia every year, the latest data shows.
Australia ranks eighth among the world’s top 30 users of prescription opiates and pharmaceutical opioids were responsible for more than 70 per cent of opioid overdose deaths in Australia.
A multifaceted, population-wide strategy was needed to combat inappropriate and over-prescribing of opioids, Dr Larance said.
People who misused opioids needed access holistic chronic pain management, evidence-based long-term opioid treatment, and harm-reduction strategies, she said. Crackdown on codeine and opioid misuse
Chief Medical Officer Brendan Murphy said there was clear evidence of significant misuse of codeine in Australia, with almost half a million people incorrectly using painkillers containing codeine.
“It is a very real and increasing problem,” Professor Murphy said.
The federal government has taken steps to curb Australia’s opioid dependence rates, including up-scheduling low-dose codeine products.
From February 1, medicines containing even low doses of codeine will no longer be available without a prescription, bringing Australia in step with 26 other countries.
“This decision is about saving lives,” Professor Murphy said.
The move has prompted some members of the public to stockpile the drugs, but Professor Murphy said the best medical advice and research showed codeine was no better for pain than any other over-the-counter medicine.
“There are numerous studies that show that codeine is not the miracle pain relief drug that people think it is and there is compelling evidence of harm caused by overuse and abuse of over-the-counter codeine-containing medicines.
“Stockpiling over-the-counter codeine is simply a waste of time,” he said.
Federal Health Minister Greg Hunt announced an additional $16 million towards the roll-out of a national real time prescription monitoring system to directly address preventable deaths from misuse of these drugs.
A spokesperson from the department of health said the states and territories were working towards having a real-time prescription monitoring solution by the end of 2018.
Pain specialist at St Vincent’s Clinic Milton Cohen said inappropriate prescribing was the primary driver of opioid misuse.
“Chronic non-cancer pain is a complex situation and doctors have got to look at psychological and social issues. If all they are doing is prescribing medication then we are going to run into trouble,” Professor Milton said.
Chairman of Scriptwise and the AMA Council of General Practice Richard Kidd said improving education among the public and clinicians needed to be at the centre of any strategy.
Patients seeking a prescription for low-dose codeine present “an opportunity for GPs to offer much better alternatives to help manage their pain”, Dr Kidd said.
“There are a significant number of people who end up with dependency issues because they haven’t understood that codeine withdrawal creates some pain and headaches and other side effects.
“People then take more codeine, not realising they are not treating primary pain problems but secondary withdrawal problems.”
The up-scheduling of codeine has been vigorously supported by the Australian Medical Association, the RACGP and Rural Doctors, the Consumer Health Forum, Pain Australia, the National Prescribing Service Medicinewise, and hospital pharmacists.
This story Administrator ready to work first appeared on Nanjing Night Net.