Opioid dispensing 2008–18: a Queensland perspective
Benita Suckling
A B * , Champika Pattullo C , Peter Donovan C , Marcus Gallagher D , Asad Patanwala A E and Jonathan Penm A F
A School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
B Caboolture Hospital Pharmacy Department, Metro North Health, Queensland Health, Brisbane, Qld, Australia.
C Clinical Pharmacology Department, Royal Brisbane and Women’s Hospital, Queensland Health, Brisbane, Qld, Australia.
D School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Qld, Australia.
E Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
F Department of Pharmacy, Prince of Wales Hospital, Randwick, NSW, Australia.
Australian Health Review 47(2) 217-225 https://doi.org/10.1071/AH22247
Submitted: 28 October 2022 Accepted: 13 December 2022 Published: 13 January 2023
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.
Abstract
Objective This study provides an overview of opioid dispensing in Queensland from 2008 to 2018 by recipient age, drug, oral morphine equivalent and remoteness.
Methods Data were obtained from the Queensland Monitoring of Drugs of Dependence System database for 2008–18 and analysed using data from the Australian Bureau of Statistics to account for population growth. Opioid dispensing by age, drug, oral morphine equivalent and remoteness were assessed.
Results The number of prescriptions for Schedule 8 opioid medicines dispensed in Queensland increased from 190 to 430 per 1000 population over the study period (2.3-fold increase). Oxycodone had the largest increase in dispensing over the study period of 3.1-fold, with tapentadol increasing rapidly since initial Pharmaceutical Benefits Scheme listing in 2013 to the third most dispensed opioid by 2018. By 2018, opioid dispensing among the oldest Queenslanders, those aged 85+ years, occurred at triple the rate for those aged 65–84 years. When adjusted to report oral morphine equivalents (OME) in milligrams (mg), there has been an increase of approximately 1.9-fold over the study period. Results were also presented by geographical area, including a heatmap and analysis by remoteness. Prescriptions dispensed per 1000 population were 416 for major cities, 551 for inner regional and 445 for outer regional, and highlight that inner and outer regional areas have higher rates of prescriptions when compared to major cities (32 and 7% higher, respectively).
Conclusion This study highlights changes in opioid prescription dispensing by drug and OME, as well as the variation in dispensing rates when accounting for remoteness. Further studies to link statewide databases, and to better understand drivers for differences in dispensing by location, will provide valuable insights to further inform policy and service provision.
Keywords: Australia, dispensing, equivalent, medication, medicine, narcotic, opioid, oxycodone, pain, pharmaceutical, prescribing, Queensland, rates, tapentadol.
References
[1] Australian Institute of Health and Welfare. Opioid harm in Australia and comparisons between Australia and Canada. Canberra: Australian Institute of Health and Welfare; 2018.[2] Donovan PJ, Arroyo D, Pattullo C, Bell A. Trends in opioid prescribing in Australia: a systematic review. Aust Health Rev 2020; 44 277–87.
| Trends in opioid prescribing in Australia: a systematic review.Crossref | GoogleScholarGoogle Scholar |
[3] Islam MM, McRae IS, Mazumdar S, Taplin S, McKetin R. Prescription opioid analgesics for pain management in Australia: 20 years of dispensing. Intern Med J 2016; 46 955–63.
| Prescription opioid analgesics for pain management in Australia: 20 years of dispensing.Crossref | GoogleScholarGoogle Scholar |
[4] Degenhardt L, Gisev N, Cama E, Nielsen S, Larance B, Bruno R. The extent and correlates of community-based pharmaceutical opioid utilisation in Australia. Pharmacoepidemiol Drug Saf 2016; 25 521–38.
| The extent and correlates of community-based pharmaceutical opioid utilisation in Australia.Crossref | GoogleScholarGoogle Scholar |
[5] Australian Commission on Safety and Quality in Health Care. Australian atlas of healthcare variation 2015: Chapter 5.1 - Opioid Medicines Dispensing. Sydney: Australian Commission on Safety and Quality in Health Care; 2015. Available at https://www.safetyandquality.gov.au/publications-and-resources/resource-library/australian-atlas-healthcare-variation-2015-chapter-51-opioid-medicines-dispensing [verified 13 May 2022].
[6] von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies. BMJ 2007; 335 806–8.
| Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies.Crossref | GoogleScholarGoogle Scholar |
[7] Australian Bureau of Statistics. National, state and territory population. Australian Bureau of Statistics; 2021. Available at https://www.abs.gov.au/statistics/people/population/national-state-and-territory-population/dec-2021/310104.xlsx
[8] Geoscience Australia. Area of Australia - States and Territories. Symonston, ACT: Australian Government - Geoscience Australia; 2004. Available at https://www.ga.gov.au/scientific-topics/national-location-information/dimensions/area-of-australia-states-and-territories
[9] Hollingworth SA, Symons M, Khatun M, Loveday B, Ballantyne S, Hall WD, et al. Prescribing databases can be used to monitor trends in opioid analgesic prescribing in Australia. Aust N Z J Public Health 2013; 37 132–8.
| Prescribing databases can be used to monitor trends in opioid analgesic prescribing in Australia.Crossref | GoogleScholarGoogle Scholar |
[10] Department of Health and Aged Care. Public Summary Document: Tapentadol, tablet, 50mg, 100mg, 150mg, 200mg and 250mg (as hydrochloride) (sustained release), Palexia SR® - November 2013. Canberra: Australian Government Department of Health - Pharmaceutical Benefits Scheme; 2013. Available at https://www.pbs.gov.au/pbs/industry/listing/elements/pbac-meetings/psd/2013-11/tapentadol
[11] Berecki-Gisolf J, Hassani-Mahmooei B, Clapperton A, McClure R. Prescription opioid dispensing and prescription opioid poisoning: Population data from Victoria, Australia 2006 to 2013. Aust N Z J Public Health 2017; 41 85–91.
| Prescription opioid dispensing and prescription opioid poisoning: Population data from Victoria, Australia 2006 to 2013.Crossref | GoogleScholarGoogle Scholar |
[12] Nielsen S, Degenhardt L, Hoban B, Gisev N. Comparing opioids: A guide to estimating oral morphine equivalents (OME) in research. Sydney: National Drug and Alcohol Research Centre, University of New South Wales; 2014. Contract No.: NDARC Technical Report No. 329.
[13] Nielsen S, Degenhardt L, Hoban B, Gisev N. A synthesis of oral morphine equivalents (OME) for opioid utilisation studies. Pharmacoepidemiol Drug Saf 2016; 25 733–7.
| A synthesis of oral morphine equivalents (OME) for opioid utilisation studies.Crossref | GoogleScholarGoogle Scholar |
[14] Australian Bureau of Statistics. 2016 Census All person QuickStats. Australian Bureau of Statistics; 2021. Available at https://www.abs.gov.au/census/find-census-data/search-by-area
[15] Australian Bureau of Statistics. Postcode 2017 to Remoteness Area 2016. Australian Bureau of Statistics; 2018. Available at https://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/1270.0.55.005July% 202016?OpenDocument
[16] Raffa RB, Elling C, Tzschentke TM. Does ‘Strong Analgesic’ Equal ‘Strong Opioid’? Tapentadol and the Concept of ‘µ-Load’. Adv Ther 2018; 35 1471–84.
| Does ‘Strong Analgesic’ Equal ‘Strong Opioid’? Tapentadol and the Concept of ‘µ-Load’.Crossref | GoogleScholarGoogle Scholar |
[17] Wang X, Narayan SW, Penm J, Patanwala AE. Efficacy and Safety of Tapentadol Immediate Release for Acute Pain: A Systematic Review and Meta-Analysis. Clin J Pain 2020; 36 399–409.
| Efficacy and Safety of Tapentadol Immediate Release for Acute Pain: A Systematic Review and Meta-Analysis.Crossref | GoogleScholarGoogle Scholar |
[18] van der Schrier R, Jonkman K, van Velzen M, Olofsen E, Drewes AM, Dahan A, et al. An experimental study comparing the respiratory effects of tapentadol and oxycodone in healthy volunteers. Br J Anaesth 2017; 119 1169–77.
| An experimental study comparing the respiratory effects of tapentadol and oxycodone in healthy volunteers.Crossref | GoogleScholarGoogle Scholar |
[19] Dart RC, Surratt HL, Le Lait MC, Stivers Y, Bebarta VS, Freifeld CC, et al. Diversion and Illicit Sale of Extended Release Tapentadol in the United States. Pain Med 2016; 17 1490–6.
| Diversion and Illicit Sale of Extended Release Tapentadol in the United States.Crossref | GoogleScholarGoogle Scholar |
[20] Kwong WJ, Hammond G, Upmalis D, Okamoto A, Yang M, Kavanagh S. Bowel function after tapentadol and oxycodone immediate release (IR) treatment in patients with low back or osteoarthritis pain. Clin J Pain 2013; 29 664–72.
| Bowel function after tapentadol and oxycodone immediate release (IR) treatment in patients with low back or osteoarthritis pain.Crossref | GoogleScholarGoogle Scholar |
[21] Blyth FM, March LM, Brnabic AJM, Jorm LR, Williamson M, Cousins MJ. Chronic pain in Australia: a prevalence study. Pain 2001; 89 127–34.
| Chronic pain in Australia: a prevalence study.Crossref | GoogleScholarGoogle Scholar |
[22] Buckeridge D, Huang A, Hanley J, Kelome A, Reidel K, Verma A, et al. Risk of injury associated with opioid use in older adults. J Am Geriatr Soc 2010; 58 1664–70.
| Risk of injury associated with opioid use in older adults.Crossref | GoogleScholarGoogle Scholar |
[23] O’Neil CK, Hanlon JT, Marcum ZA. Adverse effects of analgesics commonly used by older adults with osteoarthritis: focus on non-opioid and opioid analgesics. Am J Geriatr Pharmacother 2012; 10 331–42.
| Adverse effects of analgesics commonly used by older adults with osteoarthritis: focus on non-opioid and opioid analgesics.Crossref | GoogleScholarGoogle Scholar |
[24] Queensland Health. About Qscript. Brisbane: Queensland Government - Queensland Health; 2022. Available at https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/medicines/real-time-reporting/about-qscript
