This paper by Emily Karanges, which won the HSRAANZ Award for the Best Paper by an Emerging Researcher, describes trends in prescription opioid use in Australia over 25 years, since 1990, and maps these trends against major changes to opioid regulation and subsidy. Using data on both subsidised and unsubsidised prescriptions dispensed from community pharmacies and private hospitals, the study revealed a 4-fold increase in dispensing, as measured by defined daily doses (DDD)/1000 pop/day. There was a clear shift over time from short- to long-acting opioids and from weaker to stronger opioids.
While regulatory changes had little immediate effect on opioid use, the subsidy of long-acting formulations and the expansion of subsidy to include the treatment of non-cancer pain were major precipitators of growth. With the uncertainty about the long-term efficacy of opioids in chronic non-cancer pain and current attempts to curb opioid use and harms, the impact of these policy changes on utilisation should not be overlooked.
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