May 2024
Reduced dispensing of immediate-release opioids following tightened PBS restrictions
By Dr Emily Lathlean MB BS, FRACGP
PBS-subsidised dispensing of opioid medications declined during the 12 months following the June 2020 changes to the PBS, according to a recent Australian study.
In response to concerns about the high number of deaths and hospitalisations due to prescription opioids, the PBS changes included tightening of PBS prescribing restrictions for publicly subsidised opioid medications and the introduction of half-pack product formulations for immediate-release (IR) opioid medications. The study, published in the Medical Journal of Australia, analysed PBS dispensing data claims for a randomly selected 10% sample of PBS-eligible residents from mid-2018 until mid-2021 and also IQVIA national opioid medicine sales data.
During the 12 months following the PBS changes, PBS-subsidised opioid medicine dispensing was about 3.8% lower than the two years prior. The decline in prescribing was seen to accelerate for IR formulations, especially paracetamol/codeine (-11.7%) and tramadol (-28.6%), but the downward trend in all opioid and controlled-release (CR) opioid prescribing was not significantly changed. Repeat opioid dispensing decreased by 6.1%.
‘These percentage decreases in prescribing sound small but the numbers translate to thousands of tablets of IR opioids not dispensed into the Australian market, relative to pre-2020,’ said Associate Professor Ivan Rapchuk, Anaesthetist at Northside Anaesthesia and Director of Anaesthesia at The Prince Charles Hospital, Brisbane. ‘The harm reduction in this decreased prescribing is massive.’
There was no significant change to total daily sales of opioid medications. The researchers noted that some people may have bypassed the new restrictions by switching to private prescriptions.
‘PBS data are important; however, as restrictions increase on PBS prescribing, we need to understand private market opioid use to gain a comprehensive picture of opioid utilisation in Australia,’ said Professor Rapchuk, who is also Chair of the Opioid Stewardship Working Party.
Half-pack sizes made up 8.4% of PBS- subsidised IR opioid medicine dispensing and 2.8% of all opioid medicines. Professor Rapchuk said this was disappointing and encouraged Australian prescribers to consider prescribing smaller packs of IR opioids to reduce the risks of addiction and overdose.
‘Since the 1990s, the prescribing of opioids has increased significantly despite the fact that opioids used for chronic non-cancer pain are generally ineffectual, especially long term. The plateauing of this trend is gratifying,’ said Professor Rapchuk. ‘It would be more satisfying to see an equal downward prescribing in CR opioids, but hopefully the trend in IR [opioid prescribing] is reflective of less overall new patients on opioids in Australia and overall more thoughtful prescribing.’