Factors of Opioid Misuse in Australia

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Table of Contents

Introduction
Review of the Literature
Findings
Discussion
Conclusion
Reference List

Introduction

Many prescription drugs are misused, including growth hormones and anabolic steroids. However, opioids are among the most commonly misused drugs. This has become a serious problem in Australia as the misuse of opioid medications has increased over the years. Opioid drugs are among the most powerful analgesics but also among the most addictive. Medically prescribed opioids are generally safe when used as prescribed, but they can become harmful if misused. Examples of misuse include taking more than the prescribed dose or mixing opioids with other medications or with alcohol. This misuse can lead to several adverse health consequences that are serious and preventable. These can include but are not limited to severe respiratory depression, seizures, heart failure, and even death. Additionally, this population may be at risk for other risky behaviors that can contribute to further adverse outcomes. Apart from those deliberately seeking hedonic drug effects, vulnerable individuals may use substances including psychoactive prescription drugs to make themselves feel better. This new, hidden population may differ from the usual drug user stereotypes and be more highly functioning, have higher socioeconomic status, better education, and more social support. The aim of this paper is to identify factors that contributed to opioid misuse in Australia.

Review of the Literature

This study is based on a review of relevant empirical research from academic, government, and non-government sources. Academic sources included JAMA Psychiatry, PubMed, and Proquest. Government and non-government sources included the Australian Institute of Health and Welfare, Australia’s National Drug and Alcohol Research Centre, and the United Nations Office on Drugs and Crime. In compiling this summary of key issues, preference was given to robust empirical research and data collection. Key findings are presented in two parts. The first explores the social and environmental conditions, key events, and features of synthetic opioids that led to the current epidemics in Australia. The second discusses the connection between the concepts in the literature review and the effect of opioid misuse in our society.

In 2020, there were 1,073 opioid-induced deaths among Australians, says a new study published by researchers at the National Drug and Alcohol Research Centre (NDARC), UNSW Sydney. The majority of drug-induced deaths were due to unintentional drug overdose and opioids were the most commonly identified substances involved (Chrzanowska et al., 2022).

Findings

In the data collection exercise, there were 99 entries on the drug classification opioid, including heroin, codeine, and methadone. This is not surprising, given that opioid drugs are among the most powerful analgesics but also among the most addictive (Volkow et al., 2019). However, I noticed that even though opioid is classified as a drug, pharmaceutical opioids such as oxycodone, fentanyl, and morphine are often prescribed for the management of strong pain. These types of opioids are classified as analgesic medicine and have the purpose of relieving pain and treating respiratory illness. This finding from the data led me to explore more and found that opioid misuse has become a crisis, not only in Australia but also in the USA and Canada (AIHW, 2018). In this case, opioid misuse is defined as the inappropriate or excessive use of opioids. In 2019, another research by the AIHW showed that over 8% of Australians aged 14 years and older reported having used prescription opioids for non-medical purposes. This attracted my interest to start the research question of why opioid misuse has become a crisis in Australia.

Discussion

The study indicates the issue of opioid misuse by the Australian population and its impact on people’s health and society in general. At the same time, the review of relevant literature demonstrates that opioid misuse is directly connected with healthcare-related systemic issues. According to the Australian Department of Health and Aged Care (2019), one of the contributing factors that determine the increase in opioid misuse is a lack of reliable research. Thus, opioids are used to soothe pain in the case of various types of chronic non-cancer conditions “despite limited evidence of efficacy or safety for opioids in many of those patients” (Australian Department of Health and Aged Care, 2019, par. 2). In addition, the application of opioids for chronic pain “is also driven by the inconsistent efficacy of alternative medicines,” such as antidepressants, muscle relaxants, non-steroidal anti-inflammatory drugs (NSAIDs), and gabapentin (Australian Department of Health and Aged Care, 2019, par. 2). Moreover, opioid analgesics are frequently prescribed when pain cannot be dealt by other treatments. Thus, inappropriate or excessive use of opioids in Australia leads to their misuse and associated health issues.

Another factor in the increase in Australia’s opioid misuse is a lack of professional skills and knowledge related to modern and more efficient pain medications. In particular, Australian dentists excessively prescribe opioids, such as the combination of paracetamol with codeine, regardless of the availability of safe NSAIDs (Teoh, et al., 2020). In addition, inappropriate medical skills are associated with the absence of a patient’s medical history or assigning inadequate treatment (Cragg et al., 2019; Lalic et al., 2018). Moreover, the devastating consequences of opioid misuse are directly connected with the accessibility of health care. According to the Australian Institute of Criminology, “fentanyl use is highest in less populated and more remote locations, and in areas with greater socio-economic disadvantage and a higher proportion of older people” (Brown and Morgan, 2019, p. 7). In other words, when quality health care is inaccessible, people use opioids for pain relief without knowing the appropriate dosage.

At the same time, even the availability of healthcare services cannot guarantee the absence of opioid misuse. Thus, according to Luckett et al. (2020), opioid-related misuse is connected with poor continuity of health care and poor communication between a healthcare provider and a patient that limits shared understanding and shared prescribing arrangements. In addition, a lack of patient-doctor cooperation leads to the absence of patient education. In other words, patients are not provided with essential information related to the negative consequences of opioid misuse, such as mixing opioids with other medications or alcohol. Moreover, a patient’s opinion may be ignored, especially in the case of standard overprescribing on discharge when a patient’s concerns related to this unnecessary practice are not considered. Finally, the standards of the modern healthcare system limit specialists’ involvement (Luckett et al., 2020). In other words, due to time constraints, healthcare specialists cannot provide quality and patient-centered pain management.

In general, regardless of multiple medication variants, opioids are still regarded as the most appropriate and non-stigmatized option for pain management, especially in the case of chronic pain. However, multiple problems that exist in the healthcare system, including the inaccessibility of healthcare services, a lack of specialists’ professional skills, and the absence of patient-doctor cooperation and patient education, lead to increasing opioid misuse. In this case, responsive actions should primarily presuppose the broader changes in the Australian health care system.

Conclusion

All opioid types showed stable or declining rates in 2018-2020 relative to 2017. Although overprescription of opioid medications triggered the opioid crisis, improving opioid prescription practices for pain management, although important for addressing the opioid crisis, is no longer sufficient. In parallel, strategies to expand access to medication for OUD and improve treatment retention, including the more active involvement of psychiatrists who are optimally trained to address psychiatric comorbidities, are fundamental to preventing fatalities and achieving recovery. Research into new treatments for OUD, models of care for OUD management that include health care, and interventions to prevent OUD may further help resolve the opioid crisis and prevent it from happening again.

Reference List

AIHW (Australian Institute of Health and Welfare) (2018) Opioid harm in Australia: and comparisons between Australia and Canada, AIHW, Australian Government.

Australian Department of Health and Aged Care (2019) Addressing prescription opioid use and misuse in Australia.

Australian Institute of Health and Welfare (2020) National Drug Strategy Household Survey 2019. Canberra: AIHW.

Brown, R. and Morgan, A. (2019) ‘The opioid epidemic in North America: implications for Australia.’ Australian Institute of Criminology, 578, pp. 1-15.

Chrzanowska, A., Man, N., Sutherland, R., Degenhardt, L. & Peacock, A. (2022). Trends in overdose and other drug-induced deaths in Australia, 1997-2020. Sydney: National Drug and Alcohol Research Centre, UNSW Sydney. DOI: 10.26190/ke9y-4731

Cragg, A. et al. (2019) ‘Risk factors for misuse of prescribed opioids: a systematic review and meta-analysis.’ Annals of Emergency Medicine, 74(5), pp. 634-646.

Lalic, S. et al. (2018) ‘Predictors of persistent prescription opioid analgesic use among people without cancer in Australia.’ British Journal of Clinical Pharmacology, 84(6), pp. 1267-1278.

Luckett, T. et al. (2020) ‘Risk of opioid misuse in people with cancer and pain and related clinical considerations: a qualitative study of the perspectives of Australian general practitioners.’ BMJ Open, 10(2), pp. 1-11. doi:10.1136/bmjopen-2019-034363

Teoh, L. et al. (2020) Dental opioid prescribing rates after the up-scheduling of codeine in Australia. Scientific Reports, 10(1), pp. 1-6.

Volkow N. D. et al. (2019) ‘Prevention and treatment of opioid misuse and addiction: A review. JAMA Psychiatry, 76(2), pp. 208–216. doi:10.1001/jamapsychiatry.2018.3126

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