In June 2020, PBS changes were introduced along with new regulatory changes aimed at restricting the long-term use of opioids. These changes were implemented to reduce hospitalisations and deaths caused by opioids. Some of the associated measures included reducing pack sizes of opioid medications to just 10 tablets, restricting repeat prescriptions and encouraging doctors to wean their patients off the drugs where possible while not prescribing to ‘opioid naïve’ people.
These changes are well meaning, but are not necessarily well implemented. I am reminded of the term ‘cobra effect’ derived from an occurrence during India under British rule. The British government was concerned about the number of venomous cobras in Delhi and offered a bounty for every dead cobra. Initially, this was a successful strategy. Large numbers of cobras were killed for the reward. Eventually enterprising people began to breed cobras for the income. When the government became aware of this, the reward program was scrapped so the cobra breeders set their now-worthless snakes free. The end result was that the wild cobra population in British controlled India further increased.
Long-term use of opioids can lead to serious harm and sustained opioid use is not recommended in managing chronic pain. But we also know that for many people, there are few viable and affordable alternatives to help them manage their pain. There is a lack of pain specialist services and long wait times for the 3.4m Australians living with chronic pain. Access to effective pain management is the exception rather than the rule.
Painaustralia regularly hears from consumers about how they manage their pain and how these recent regulatory changes have affected them. We hear stories about consumers living in rural areas now feeling like they are treated like drug dealers for needing more than 10 tablets to manage their chronic pain condition. We hear people’s experiences of how doctors are reluctant to see them because they have chronic pain and the potential extra scrutiny that may come with prescribing opioids. We hear the anguish that consumers express about a GP cutting off supply of their medication, leaving them without a lifeline and turning to alcohol, cannabis and other drugs for pain relief. One consumer described it as being lost at sea and then suddenly having your life preserver taken away.
We’ve made this a drug problem, rather than a chronic pain problem. We claim it is a health measure without considering the impact on the patient. We already know that people are hopping from one sub‑optimal solution to another without moving towards a multidisciplinary approach – the most effective, evidenced‑based approach to pain management.
Consumers and doctors say they received little warning about these changes and that there wasn’t an advertising campaign or helpline. Worse still, many people with chronic pain were given no alternative to help them cope. Some pain patients report being forced tapered without appropriate support which can be dangerous and is certainly inhumane.
In February this year, the Government began rolling out a consumer awareness campaign. While it is long overdue, we do support the Government’s effort through the Therapeutic Goods Administration to fund pragmatic solutions to support consumers affected by these changes. One of these solutions is funding an update to the National Pain Services. The Directory is a repository of pain specialists and associated services across Australia that consumers can access to find support in their area. You can use it free of charge here.
Further government funding has been provided for public awareness and education about these changes through a national consumer awareness campaign, which will run for another few weeks. You should see advertisements on Facebook, Twitter and your local GP and Pharmacy.
A number of organisations: NPS Medicinewise/NACCHO, Carer’s Australia, MensLine and Society of Hospital Pharmacists, Federation of Ethnic Community Councils of Australia, Men’s Shed Association and HealthDirect, have also been funded by government to raise awareness for their communities about the changes.
While these activities are sorely needed, campaigns such as this should form part of a national strategy to support people living with chronic pain.
The lack of a national approach has clearly impacted how the opioid regulatory changes were developed and implemented and led to some adverse consequences. Federal, State and Territory health ministers are now considering The National Strategic Action Plan for Pain Management. As our members will likely know, the Plan outlines key steps towards a national and holistic policy framework that will support consumers, health practitioners and the wider community to improve the quality of life for people living with pain, their families and carers and minimise its impact. We remain hopeful that a national approach to chronic pain will be the result.
So what is the upshot? The new measures restricting opioids go some way to addressing concerns about the potential harms. But they do not address the gaping hole that remains in providing effective, affordable, alternative treatment for chronic pain.
When we combine all the new opioid measures with the current roll out of Real Time Prescription Monitoring or boxed warnings for Lyrica for instance, you cannot help but wonder whether the benefits of these changes will outweigh the costs. It would be wrong to remove access to a treatment many people experiencing pain have become reliant upon without providing an adequate alternative. This is exactly the kind of cobra effect we must work to avoid.
Carol Bennett, CEO
We’d love to hear your thoughts about this article and whether the opioid regulatory changes have affected you. Please email us at firstname.lastname@example.org and follow us on Facebook and Twitter (@painaustralia) to hear updates about the Plan.
Key questions:Have the Government’s opioid regulatory changes affected you? Do you now use alternatives such as Lyrica, alcohol or non-medicinal cannabis to manage your condition?
What do you think of the Government’s awareness campaign? Have you seen it; do you agree with the message; does it help you?