The introduction of strong pain killers that can’t be crushed or dissolved has done little to tackle Australia’s opioid epidemic, a study has found.
Amid concerns about rising rates of opioid addiction and misuse, in 2014 high-strength oxycodone tablets — known as OxyContin — were reformulated to make them tamper-proof so that patients couldn’t inject, snort, chew or smoke them.
But researchers from the National Drug and Alcohol Research Centre found the tamper-proof pills had no significant impact on opioid use and harm overall.
“Although the introduction of this tamper-resistant formulation resulted in less use of that particular opioid among people who inject drugs, their introduction must be considered as part of a multifaceted response,” said lead author Dr Briony Larance.
That’s because only a small percentage of people who misuse prescription medications tamper with them, while the large majority simply swallow them.
“Approximately 2.9 million Australians were prescribed an opioid in 2014, compared with an estimated 93,000 people who injected drugs,” Dr Larance said.
“As a population-wide strategy to reduce harm of overuse or overprescription of opioids, the introduction of tamper-resistant formulations alone will not be sufficient to affect these outcomes.”
Opioid use on the rise
The study, published in The Lancet Psychiatry, analysed Australian opioid sales and health data before and after the introduction of the tamper-resistant oxycodone tablets.
They also surveyed 600 people who misuse prescription opioids.
The researchers found sales of the high-strength, tamper-resistant OxyContin tablets had gone down, but this was offset by an increase in sales of lower-strength, non-tamper-resistant oxycodone formulations.
In Australia, opioid use has continued to increase at a similar rate as it did before the tamper-resistant tablets became available, with no impact on the rates of harm and hospital admissions.
“We found there was no increase in people seeking help for oxycodone, and no increase in emergency department data for overdoses,” Dr Larance said.
‘It’s changed my life dramatically by coming off the drugs’
John didn’t realise how dependent he’d become on opioids to control his pain until he tried to get off the drugs.
After a horror bike crash in 2015, John spent six weeks in intensive care, and had to have an operation to shave down four of the vertebrae in his neck.
“I was an intense, almost electric pain throughout my body,” he said.
As he learned to walk again, his rehab doctors gave him a cocktail of powerful painkillers including oxycodone, fentanyl and morphine to manage his nerve pain.
“I was on a lot of drugs for a long, long time. I must have been in a haze — I wasn’t very lucid — and my wife made a few comments that I wasn’t the same person,” John said.
Eighteen months after his accident, John’s friend encouraged him to apply for ADAPT program at Sydney’s Royal North Shore Hospital.
The intense three-week course weans patients off opiates and teaches them new methods to manage pain without drugs.
After leaving the pain clinic, John found himself battling intense withdrawal symptoms including nausea and headaches.
“But a couple of months after the program, those conditions started to subside. And then one day, it was like a veil had lifted right in front of my face. I became lucid again,” John said.
John now uses mediation, yoga and light exercise to manage his pain.
“It’s changed my life dramatically by coming off the drugs,” he said.
“It was really interesting — after I came off the drugs, the pain levels stayed the same. So they weren’t really doing anything for me anyway.
“I find that if I’m active, I can keep the pain levels to a certain degree where I’m comfortable.”
Experts call for new methods to tackle opioid crisis
Researcher Dr Briony Larance says alternative methods including pain clinics are required to combat Australia’s opioid addiction crisis.
“This includes increasing the availability of non-medication approaches to chronic pain, good clinical practice in long-term opioid treatment, and harm reduction among people who use opioids outside the recommendations of their prescriber,” she said.
In 2016, Australia recorded its highest number of drug-induced deaths in since the 1990s, with prescription medication being largely blamed for the significant increase.
“We are finding people are taking more [oxycodone], misusing it, and taking it for too long,” Dr Larance said.
“If patients are prescribed an opioid, it should be treated as a trial, with the patients reviewed regularly.”
In July 2017, the Federal Government announced it would invest $16 million in a national roll-out of real-time prescription monitoring, which will alert pharmacists and doctors if patients receive multiple supplies of prescription-only medicines.
In February 2018, painkillers containing codeine will no longer be available over the counter.