Painkiller packs cut down to size as opioid crackdown intensifies

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Painkiller packs cut down to size as opioid crackdown intensifies

By Aisha Dow

The drugs have become household names in Australia: oxycodone, codeine, morphine and tramadol.

But from next week they will become even harder for people to access, as pack sizes are halved and doctors are told to dispense only to patients whose other treatments have failed.

Products impacted by the regulatory changes include tramadol, tapentadol, codeine, buprenorphine, hydromorphone, morphine, oxycodone and fentanyl.

Products impacted by the regulatory changes include tramadol, tapentadol, codeine, buprenorphine, hydromorphone, morphine, oxycodone and fentanyl.Credit: AP

The crackdown is in response to thousands of deaths linked to prescription opioids - almost 100 each month in Australia.

While doctors and pain experts strongly back the changes, they also warned that patients needed to be given support to avoid the unintended consequences, such as overdoses, of people turning to illicit or black market alternatives.

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The changes, to be introduced from June 1, would require patients who have used prescription opioid painkillers for a year to have their cases reviewed by another doctor or pain specialist.

It is understood the size of opioid-based painkiller packs, including codeine and hydromorphone, will be cut in half, from 20 tablets to 10, and no repeats will be allowed unless a special exemption is sought and received by a doctor.

"To be eligible for treatment with opioids, patients will need to be unresponsive or intolerant, or have achieved inadequate relief of their acute pain, to maximum tolerated doses of non-opioid treatments," a statement on the Pharmaceutical Benefits Scheme website said.

Products impacted by the regulatory changes include tramadol, tapentadol, codeine, buprenorphine, hydromorphone, morphine, oxycodone and fentanyl.

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Larger packs of medication will be available to patients who require long-term treatment of chronic pain with opioids, and doctors will be able to request authorisation of additional medication or repeats, a health department spokeswoman said.

"Importantly, the changes will not reduce access to opioid prescription medicines for people with cancer-related pain or those in palliative care," she said.

The Royal Australian College of General Practitioners’ chairwoman of addiction medicine Hester Wilson said reduced pack sizes meant people would only receive a day or two's worth of painkillers.

Dr Wilson said many of these larger packs were not fully used "so they were sitting around in people's medicine chest … or being given to friends or family".

She said if people were being discharged from hospital after surgery and still needed pain relief after 10 tablets, they should return to their doctor anyway.

"It means that things need to be looked at again," Dr Wilson said.

"There will be a group of people [who] do need additional opioids for a long period of time, however, that really needs to be done in a supervised, ordered way."

The college of GPs has highlighted the importance of getting naloxone, a drug that can reverse opioid overdose via a nasal spray, to patients who may be at risk and ensuring that pharmacotherapy and drug treatment services were available.

"Withdrawal from opioids is very, very unpleasant," Dr Wilson said.

"And there is a risk that people will then turn to buying things from friends or buying them from people that they know and not actually have the level of medical supervision and support they need to ensure that they remain safe."

Despite continued tightening of restrictions to opioid access in recent years, prescriptions have continued to rise. There were 15.42 million scripts dispensed in 2016-17, an increase from 13.08 million since 2012-13.

Meanwhile, large sections of the Australian population live with daily pain, an estimated one in five people over the age of 45.

Paula Ellis has struggled with a dependence on painkillers since she was a teenager.

Paula Ellis has struggled with a dependence on painkillers since she was a teenager.Credit:

Paula Ellis, 50, wishes it hadn’t been so easy for her to get hold of painkillers when she was a teenager and first developed migranes, triggering a lifetime battle with opioid misuse, which she has begun to get under control with treatment.

"It was always available. It didn’t matter where I was in the house, it was there."

Later on, the mother-of-two went from chemist to chemist to get packets of codeine.

"I could take 40 or 50 tablets a day, it was terrible," she said. "I’ve lost a lot of my life to it."

Pain Australia chief executive Carol Bennett has welcomed the changes but warned against people being rapidly taken off medication and without proper support.

Ms Bennet said the smaller pack sizes could help prevent people from being sent home from hospital with more than they needed.

"People suddenly put onto opioids can become dependent really quickly – sometimes it can happen within three days," she said.

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