Regulatory and other responses to the pharmaceutical opioid problem

In the last twenty years there have been substantial increases in the use of pharmaceutical opioids in many countries, including Australia which has one of the highest levels of opioid utilisation globally 1. Almost 15 million opioid prescriptions were dispensed in 2015 and our use of high-potency opioids has also increased 2. One of the main drivers is the increased use of prescription opioids for chronic non-caner pain (CNCP) 3. In parallel to escalating use, opioid-related harms have also increased. Since 2000, there has been a shift in both hospitalisations due to opioid poisonings and opioid-related deaths, from predominantly heroin to pharmaceutical opioids4. Use pharmaceutical opioids for non-medical purposes is also relatively common, reported by 4.8% of the Australian population4. A range of possible strategies to minimise unnecessary opioid exposure and adverse events were highlighted in the National Pharmaceutical Drug Misuse Framework for Action (2012–2015) 5 including: coordinated medication management systems (prescription drug monitoring programmes (PDMPs); improvement of access to pain and addiction services; development of resources, and workforce development. To date, few of these strategies have been implemented. We summarise recent and emerging responses in Australia that aim to minimise harms from pharmaceutical opioids. Regulatory responses aimed at reducing aberrant opioid prescribing and restricting opioid supply Codeine rescheduling In 2016, the most common analgesics used for non-medical purposes by Australians were over-the-counter (OTC) codeine products4. There have been several attempts to reduce extra medical use and harms from OTC codeine. In May 2010, OTC codeine products were up-scheduled from Schedule 2 (Pharmacy Medicine) to Schedule 3 (Pharmacist Only Medicine). This change, however, had no meaningful impact on codeine poisonings 6. They were subsequently up-scheduled again in February 2018 to Schedule 4 (Prescription-only medicines). The impacts of this decision remain to be seen 7.