This review of the evidence on opioid medications in Tasmania, and also nationally and internationally, has brought up a number of important observations on the changing landscape in Schedule 8 (S8) opioid medication availability, prescribing, and the changes in the regulation of these potent medications that have occurred in Australian jurisdictions and internationally.
In Section One, the review of the international and national literature identifies consistent and substantial increases in opioid analgesic prescribing across a range of developed nations since the early 1990s. These changes have occurred mainly in the developed and resource rich countries, in particular North America and Western Europe. The increase in prescribing has been in large part a consequence of the pharmaceutical industry developing new products that include slow- release formulations. Much of this increase is driven by prescribing for chronic non-malignant pain, a condition about which there is considerable debate regarding the role of opioids in management. Increases in prescribing have occurred in Tasmania since the late 1990s, with a six- to seven-fold increase in prescribing authorities for opioids over a 12-year period. The increase in authorities for opioid analgesics, which are required for prescribing beyond two months, suggests an increase in chronic opioid therapy (COT) for chronic non-cancer pain.
There is growing concern both internationally and locally about the harms associated with these drugs amongst chronic pain patients, and about extra medical use and diversion. These concerns are based on peer reviewed studies of opioid-related deaths and other harms amongst chronic pain patients and injecting drug users (IDU), primarily in the United States; are shared by a number of medical practitioners and other health professionals in Tasmania; and are borne out by the analysis of Tasmanian and Australian data in Section Two.