Australian trends in opioid prescribing for chronic non-cancer pain, 1986-1996

Abstract

Objective: To identify trends in the use of opioid drugs for chronic non-cancer pain.

Design: Review of three sets of official records-the record of Schedule 8 (S8) opioid drugs used in Australia, 1984-1995, from the national Department of Health, Housing and Community Services; New South Wales Department of Health statistical summaries of the number of authorities to prescribe S8 drugs for cancer pain and non-cancer pain for each June from 1990 to 1996; and NSW Department of Health patient records for a cohort of patients first prescribed S8 drugs in 1991.

Main outcome measures: Total quantities of opioids used in Australia; numbers of S8 authorities issued in NSW. Outcome measures for the cohort study were the proportion of patients remaining on opioids long-term, the proportion for whom dose escalated over time, and the diagnoses for which opioids were being prescribed.

Results: Between 1986 and 1995, the amount of oral morphine used in Australia rose from 117 to 578 kg. Use of all other oral S8 opioids combined increased from 93 to 149 kg. In NSW, the number of authorities to prescribe for non-cancer pain rose from 3326 in June 1990 to 5743 in June 1996 (73% increase), while cancer pain authorities rose from 2652 to 4831 (82% increase). Sixty-nine of the 102 patients ceased to receive drugs on authority over the five year follow-up. These subjects received opioids for a mean of 19 months. Among the remaining 33 subjects, dose escalation was common. Diagnostic information indicated that may patients had significant psychological and social problems.

Conclusions: There has been a dramatic increase in opioid prescribing, a substantial proportion of which is for non-cancer pain. In a sample of patients being treated for non-cancer pain, long term use and dose escalation occurred in one third of cases.