Research into new statewide prescription drug monitoring program finds limited impact on high opioid prescribing

Led by Professor Suzanne Nielsen and funded through a National Health and Medical Research Council Ideas Grant, the study examined the impact of introducing a prescription drug monitoring program to the ways that doctors prescribe opioids and other analgesics. 

In contrast to the intended outcomes of the new Victorian prescription monitoring program, the study found no change in the number of high-dose opioids being prescribed.

Aim to reduce harms from prescription opioids

Opioids are prescribed to relieve pain and to treat opioid dependence, but they are also linked to harms as a result of medical use. Changes to the ways that prescription opioids are dispensed were implemented in April 2020 in response to Australia’s increasing numbers of deaths related to prescribed opioids. 

Doctors and pharmacists are now alerted when a patient receives a prescription for a high-dose opioid or high-risk combinations of drugs, or when a patient has visited several doctors to access multiple prescriptions. 

Both positive and negative outcomes 

While similar changes in other countries have led to positive outcomes, including fewer and lower doses of opioids being prescribed, negative outcomes have also been identified. 

Negative outcomes seen internationally include situations when patients are prescribed a medication for chronic pain that is less effective than opioids, refused care based on their medication history, or face stigma based on the information included in their medication record.

Some unexpected results 

In contrast to expectations, the study did not find any changes in how often high doses of opioids or high-risk combinations of medicine were prescribed. 

Possible reasons identified by the researchers include the challenges that people can face when cutting back on opioids, a lack of uptake among pharmacists and doctors, and a possible lack of enforcement for the process despite it being compulsory. 

Another finding of the study is that prescriptions for some unmonitored medicines increased, which may indicate that the unmonitored medicines are being prescribed in place of opioids. The researchers highlighted concern at this finding since the alternative medicines may be less effective or may have negative side effects. 

Further research is needed

This study demonstrates the need for ongoing monitoring of prescribing practices in order to determine whether the recent changes lead to any unintended harms and whether the intended reduction in harms relating to prescription opioids occurs. 

With this goal in mind, the researchers are now looking at using linked hospital and prescribing datato further understand the outcomes of these opioid prescribing changes. 

• Read the journal publication. 
• Read more about the issue in Monash Lens.
• Access the opioid dispensing guidelines for clinical practice.