Pharmacy Daily | New opioid policies reduce ED visits

AUSTRALIAN researchers have conducted the first international study outside of the United States looking at the impact of changes in opioid prescribing policies on emergency department (ED) presentations and hospitalisations, and found that while the policy aims were broadly achieved, there were some short-lived unintended consequences.

Led by Professor Suzanne Nielsen of Monash University, the team looked at opioid-related ED presentations and hospital admissions among people prescribed opioid medications before and after the introduction of policies restricting their access.

In Australia, prescription opioids are behind most nonfatal overdoses treated in EDs and most opioidrelated deaths.

The new policies included the requirement for an online check before prescribing opioids, and changes to Pharmaceutical Benefits Scheme rules around subsidised opioids, including smaller pack sizes for treating acute pain, limits on long term opioid use, and more restricted indications for long term prescribing of opioids.

"Restricting their supply can reduce the availability of opioids and reduce the number of deaths related to prescription opioids, but these restrictions can also hinder legitimate access to opioid medications, leading to unmanaged pain and distress," the authors said.

As such, they also looked at hospital attendances due to non-opioid substances, and mental health issues, including suicide, self-harm, anxiety and depression.

The researchers found that while opioidrelated ED visits dropped after the policy changes, there was a sharp increase in nonopioid drugrelated presentations shortly afterwards.

However, those also dropped back to lower levels over the subsequent two years.

"One possible mechanism underlying the increase in nonopioid substancerelated harms could be related to increased prescribing of unmonitored pain medicines, such as pregabalin and tricyclic antidepressants, following the introduction of the prescription drug monitoring program," the authors said.

There was no real change in rates of selfharm and mental healthrelated presentations, or in overall hospital admission rates.

Some opioidrestricting policies can reduce opioidrelated harm without increasing long-term nonopioid substance or mental healthrelated harm, the researchers concluded.

"Our findings indicate that a healthfocused approach to prescription drug monitoring could avoid some of the harms reported in the United States," they said, referring to the higher number of illicit drug overdose deaths after opioid prescribing was restricted.

"As this is the first study of this type in a health care system outside the United States, our findings are of international relevance, and indicate that measuring a comprehensive range of outcomes is important when evaluating opioid policies."

Read the paper HERE. KB