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Changes to prescribing opioids

June 2020

opioids

Commencing 1 June 2020, the Pharmaceutical Benefits Scheme (PBS) listings for opioid medicines changed, in an effort to:

  1. improve pain management strategies, and
  2. to reduce the current number of deaths and hospitalisations due to opioid abuse.1 

These amendments are part of a larger group of measures aimed at encouraging appropriate use of opioids, changes to clinical guidelines and ongoing prescription and compliance.

The changes include modifications to existing restriction requirements and arrangements for increased quantities and repeats. There are also new restricted benefit listings for smaller maximum quantities of immediate release opioids, with no increased quantities or repeats, for patients requiring short-term relief of acute severe pain.2

What do the changes involve?

Opioid medications will now :

  • be available in smaller quantities
  • not include repeats for the treatment of non-chronic pain. 

To be eligible for treatment with opioids, patients will need to be unresponsive or intolerant, or have achieved inadequate relief of their acute pain, to maximum tolerated doses of non-opioid treatments.

Patients who require long-term treatment of chronic pain with opioids will still be able to access larger pack sizes and prescribers will be able to prescribe repeats where they meet the new restrictions requirements.

In order to be eligible for treatment with high strength opioids (such as morphine) patients will need to be unresponsive or intolerant, or have achieved inadequate relief of their acute pain, following maximum tolerated doses of other lower strength opioid treatments.

What medicines are affected by the regulatory changes?

Prescription opioid products affected by these changes are:

  • tramadol
  • tapentadol
  • codeine
  • buprenorphine
  • hydromorphone
  • morphine
  • oxycodone
  • fentanyl
  • methadone.

What do these changes mean for clinical practice?

These changes do not intend to impose a ban on prescribing opioids to any category of patients, if their ongoing use is clinically justified. On the contrary, they are meant to encourage practitioners to reflect on their own opioid prescribing practices, to ensure that, when either initiating or continuing to prescribe an opioid, they discuss it with their patients and consider how the risks and harms will be managed. 

What do these changes mean for prescribers?

The reduced packed size of opioids will enable a simplified way to prescribe smaller quantities of immediate release opioids for acute, short-term treatment. 

Prescribers must ensure that patients meet the relevant restriction criteria when prescribing opioids under Restricted Benefit and Authority Required (STREAMLINED) PBS listings. This ‘streamlined authority code’ is located on the relevant PBS listing on the PBS website. To prescribe an Authority Required item, the prescriber is required to request authority approval from Services Australia through the Online PBS Authorities System or by calling 1800 888 333.

In addition, patients must be referred to a pain specialist or alternative prescriber for clinical review if opioid use exceeds or is expected to exceed 12 months. The date of the review and name of the medical practitioner consulted must be provided for every authority application.

References

  1. PBS News - Revised opioids PBS listings from 1 June 2020 http://www.pbs.gov.au/info/news/2020/05/revised-opioids-pbs-listings-from-1-june-2020
  2. Therapeutic Goods Administration factsheet for health professionals https://www.tga.gov.au/prescription-opioids-information-health-professionals
     

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Life and times of a rural and remote practitioner
Dr Nicol is a dedicated rural doctor who is providing crucial medical services to the Queensland community of Winton. He has worked hard to rebuild the doctor workforce in the town,receiving the ACRRM-RDAA Rural Registrar of the Year Award for 2018.

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