A new way forward reducing opioid harm
Data, discussion and cooperation are the way forward as health professionals work to leverage promising initiatives.
The scourge of opioid dependency affects many developed countries, and Australia is no exception.
Research shows the rise in harm related to opioid products has been driven by unrealistic expectations of pain management, overprescribing and lack of evidence-based educational programs for health professionals.
For a significant number of people, the provision of opioids post-surgery is a key factor that can lead to future harm.
Demand for strong and effective pain relief after surgery will not wane anytime soon; in 2016–2017 there were over 1 million surgeries in public hospitals and 1.5 million surgeries in private hospitals, following which the prescribing, administration and dispensing of opioids is commonplace.
As medicines experts embedded in multidisciplinary care teams that treat the most unwell and vulnerable Australians, hospital pharmacists are uniquely placed to understand and address this growing crisis.
As with any public health crisis, effective action to combat the increase in opioid harm is difficult without first understanding the causes and impacts in as much detail as possible.
Harnessing the expertise of hospital pharmacists across the country, SHPA recently conducted a survey of directors of pharmacy and their delegates working in 135 public and private hospital facilities regarding pharmacy service provision, workload, prescribing practice and dispensing activities.
The resulting landscape paper identified disparate approaches to opioid stewardship in surgeries across the country and opportunities to develop or strengthen related health policy.
Some of the key, preliminary findings included that the provision of specialised services for patients with pain is varied, especially in regional and rural areas; inconsistent or inappropriate information is provided at hospital discharge; and excess quantities of opioids are being provided to patients at discharge.
In particular, the need to carefully manage medicine provision to ‘opioid naïve’ surgical patients was reported by hospital pharmacists, as this group are more vulnerable to future dependency once prescribed sustained-release opioids in treatment of acute pain.
The report’s many positive included innovative strategies, recommended for expansion, to improve patient care alongside prescriber and governance support (including opioid stewardship). Among these were statewide interventions that capitalise on pharmacy expertise through effective governance and engagement across pharmacy, medical and nursing workforces to deliver positive outcomes in prescribing, supply and prescriber education.
Recognising the need for collaborative input, SHPA held the inaugural multidisciplinary and collaborative Medicines Leadership Forum in Canberra at the end of July to explore and advance the report’s findings.
The forum gathered key representatives from across the health system, including general practitioners, anaesthetists, pharmacists, and pain management and addiction medicine specialists, as well as consumer health and government figures.
Themed ‘Reducing opioid-related harm’, the forum led to over 21 preliminary recommendations from the four working streams to inform the formal recommendations of the final report, supporting further discussions with stakeholders including hospitals regarding service provision, clinical care and governance.
SHPA’s landscape study and Medicines Leadership Forum have come at a pivotal time for opioid stewardship. Last year, the United States’ escalating opioid crisis was declared a ‘national emergency’. Meanwhile, here at home, recent research from UNSW’s National Drug & Alcohol Research Centre showed deaths related to opioid use among Australians aged 15–64 nearly doubling from 3.8 per 1000 in 2007 to 6.6 per 1000 in 2016.
The important and timely advocacy work has shown the value of hospital pharmacies equipped to innovate and empowered to address public health challenges.
With the misuse of pharmaceuticals now the greatest cause of drug-related death in Australia, broadly speaking, robust data and dynamic discussion and cooperation are the clear way forward as health professionals work to leverage the most promising initiatives on a state and national scale.
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