This week, the Department of Health through the Therapeutic Goods Administration (TGA) continued to implement a number of regulatory changes to reduce the harm caused by opioid prescription medicines to Australians, with the latest changes announced by Minister Greg Hunt on 1 June.
However, we cannot ignore the fact that these regulatory changes themselves may increase the risk of harm through rapid opioid dose reduction, which also poses risks including more severe pain and neuro-psychological effects.
It is also important to recognise that the chronic pain community is uniquely vulnerable to the harms arising from dependence and inappropriate pain management. Chronic pain is associated with neurological changes with bidirectional associations with anxiety and depression, which heightens the risk of opioid dosing and dependence.
We must learn lessons from the implementation of opioid reforms overseas, particularly in the United States. A recent report noted heightened death rates, specifically from medication overdoses (including potential self-harm), in those who undergo opioid dose reduction. This reflects reduced tolerance to opioid-related adverse effects (specifically respiratory depressant effects) making people more vulnerable to subsequent overdose, but also to increased agitation and suicidality in those whose opioids are withdrawn.
People living with chronic pain are already living through unprecedented times of concern. The current COVID-19 pandemic is placing significant stress on the chronic pain community. A person living with chronic pain in the current environment is at risk of reduced access to care, script and medication provision issues and potential symptom exacerbation via reduced physical activity and increased psycho-social stress. The regulatory reforms will add a layer of complexity to what is already a convoluted health navigation maze.
This is why Painaustralia is particularly supportive of measures that minimise the risks associated with opioid usage, such as the Federal Government’s $10 million Take Home Naloxone Pilot program. Through this pilot, consumers can access Naloxone, a drug that can temporarily reverse the effects of an opioid overdose or adverse reaction. Naloxone is currently available free and without a prescription in participating pharmacies throughout New South Wales, South Australia and Western Australia. Naloxone is easy to use and available as a Nasal spray, Pre-filled syringe or Ampoules under the Pilot program, and provides consumers with easy access to precautionary measures that can support their pain management, while minimising the risk.
It’s another weight that can help balance the scales, in the favour of the person living with chronic pain.