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06 AUGUST 2020
Over the course of the past couple of months, our office has been inundated. Since the rollout of the opioid prescribing changes on 1 June, our staff, along with the chronic pain community and prescribers, have been caught in the impact of these significant reforms.
We have had to respond to distressed phone calls, emotional emails and messages on social media, but the impact on Painaustralia and our staff is incomparable to the on-ground reality of people who previously had access to opioid treatments now being left with completely inadequate alternatives.
What went wrong? Painaustralia and other pain management stakeholders have been engaged with the Department of Health for years, seeking to inform the design and development of the Opioid reforms, how they are managed and communicated. No one doubts the need for more judicious prescribing of opioids, the evidence and research is clear: we need to do more to minimise the harm associated with widespread opioid prescribing.
The problem is that you cannot just stop prescribing opioids if there are no alternatives. You cannot minimise harm without addressing why opioid use is so high in the first place. Focusing on the prescribing alone is just one aspect of a more complex issue and if that complexity is not addressed, there is real potential to actually cause harm.
Pain management is the reason over 3 million scripts of opioids are written each year. We can apportion part of this large number of prescriptions on a lack of adequate education and awareness, people living with chronic pain and prescribers simply don’t know alternatives exist. But for the majority of the 3.37 million people living with chronic pain, the alternatives to opioids come with high barriers to access: cost, waiting time, and proximity. These barriers are real and often insurmountable to a person living with complex chronic pain. Many people simply have no access to alternatives – and that is what they are telling us as they reach a point beyond desperation.
Painaustralia’s support of these significant reforms to opioid prescribing has always been contingent on the implementation of a national, strategic approach to pain management. This is vital in ensuring that we don’t just pull out the rug of medication from under the feet of people living with chronic pain. While some components of the Plan have achieved traction, the overarching strategic approach continues to await the endorsement of Australia’s health ministers. Understandably, that has taken a backseat as the nation rallies to deal with the unprecedented public health challenge of COVID-19.
Unfortunately, COVID-19 has also had a big impact on people living with chronic pain who have seen a significant loss in access to primary care, with public pain management clinics forced to divert resources. It has been disappointing to see little or no consideration given to the fact that this is a cohort of people who are uniquely vulnerable, given their often already immunocompromised health. Even countries where the response to the pandemic leaves much to be desired ensured that people living with chronic pain continue to have access to opioid prescriptions through the pandemic to avoid withdrawals and other serious psychosocial impacts.
As Painaustralia has reported to the Opioid Regulatory Advisory Group as well as the Opioid Reform Communications Committee, the chronic pain community had already been reporting adverse health outcomes from the impact of the bushfires. The subsequent pandemic and corelated challenges in accessing primary and preventative care services have had a major effect on the chronic pain community.
The rollout of significant opioid prescribing reforms on 1 June has exacerbated challenges faced by people living with chronic pain, as has been demonstrated by the results of the survey we launched just last week. With over 500 responses in just a few days, the message is clear.
We have failed the chronic pain community yet again.
We must wakeup to the real cost of neglecting chronic pain. Over and over again, we have seen the incalculable harm of getting these policies wrong. We need to learn important lessons from countries like America that have seen a bad situation get worse because of ill considered and badly implemented reforms. Even in the week this blog is released, we see new Chronic Pain Management Guidelines from the United Kingdom, recommending the use of anti-depressants and acupuncture over ‘pain killers’.
It is impossible, reckless and downright cruel to keep ignoring the real issues here: lack of properly funded and resourced alternatives to medications to manage pain. Management of pain must be holistic in order to be effective, and so must our policies. We must stop cherry-picking the problems and focussing on half-baked solutions that are very poorly implemented.
As I return to my office at Painaustralia and meet with staff, I already know their number one concern, the anguish and pain of the people they have been talking to, some of whom are beyond breaking point. Our fear is that lives will be lost because of how badly this reform has been managed. What price will we pay in family breakdown, lost productivity, increased co-morbidities including mental illness? Surely, we can and must do better than repeating these mistakes and making people experiencing chronic pain across Australia pay for our failures?