Presentation Transcript

1. Trends and patterns in pharmaceutical use in Australia: What can we learn from those who have gone before us?

   Nicole Lee Roger Nicholas Ann Roche
2. Trends in pharmaceutical supply Source: International Narcotics Control Board Tables of Reported Statistics 2009. Available from http://www.incb.org/incb/en/narcotic_drugs_2009.html
3. USA Trends Largest per capita non-medical use in the world 2010 non-medical use of prescription medicines was second only to marijuana among young people High prevalence of non-medical use Nearly half of the world’s consumption of morphine and 99% of oxycodone but only 4.7% of the world’s population
4. USA Trends 1992-2002 population increased by 13%, prescriptions rose 57% Increased supply of prescription opioids generally Opioids 222% increase Stimulants 369% increase
5. USA trends Past month non medical use by young people declined between 2002 and 2010 Illicit use has remained high but stable for the last decade Illicit use not increasing Number of new illicit users is stable
6. Australian trends Morphine  Tramadol Non-medical use of painkillers up from 2.5% to 3% supply Illicit use Fentanyl Oxycodone 17x Supply far outstrips changes in levels of non-medical use
7. Potential theories
8. Potential theories
9. Diversion and illicit use Fischer & Rehm, 2006
10. Diversion and illicit use
11. Diversion and illicit use Stafford & Burns, 2011
12. Potential theories
13. Ageing population Increase in prescription opioids among older Australians (Roxburgh et al, 2011) NDHS data shows the highest painkiller use among 20-29yo (5.4%) (AIHW, 2011)
14. Potential theories
15. Marketing of opioids in the USA Significant marketing changes with the introduction of oxycodone in the US (Van Zee, 2009) Period of liberalisation of use of opioids for treatment of chronic non-cancer pain Promoted with unusual intensity High intensity academic detailing and incentives Direct to consumer advertising in the USA Tighter controls in Australia – protective?
16. Potential theories
17. Lack of awareness among prescribers, dispensers and the community Knowledge gaps Ineffective and incoherent prescription monitoring programs Lack of a comprehensive national prescription monitoring Manchikanti, 2007
18. Potential theories
19. Opioids in chronic pain management Reduced stigma Increased use in cancer pain Increased use in chronic non-cancer pain Slow release options Pain as the 5th vital sign Intolerance of undertreated pain in USA
20. Why do we care? Large steady increase in deaths after the introduction of oxycodone in Canada (Dhallaet al., 2009) Increase in emergency department visits tracks supply (Wisniewski et al.,2008) Harms increase with increases in licit or illicit use and supply Association between opioid pharmaceutical potency and morbidity in the community (Dasgupta et al., 2006) Increase in drug poisonings associated with supply (Paulozzi et al., 2006) Increase in deaths including oxycodone associated with increased supply (Rintoul et al., 2011)
21. What can we do?
22. What can we do? Electronic recording and reporting of controlled drugs (ERRCD) Monitoring supply Identification of prescription shopping Prevent dispensing of lost prescriptions Flag problem prescribing or dispensing