The use of oxycodone, a strong painkiller and Class B controlled drug, has been the subject of debate in the medical community. It is a synthetic, opium-like drug which provides highly effective pain relief, particularly for short-term, severe pain, such as after surgery or an accident.
For some people, ongoing use of opioids, the drug family oxycodone is from, is the best option for relief from debilitating pain, allowing a chance to function with relative normalcy.
Despite proven benefits, however, many opioids, including oxycodone, have addictive properties.
Addiction specialist and psychiatrist Dr Jeremy McMinn said oxycodone was a highly addictive opioid when used regularly, and its use in New Zealand has been under scrutiny for almost a decade.
Oxycodone prescriptions skyrocketed in New Zealand 249 per cent between 2007 and 2011, before "mounting international evidence for adverse effects, addiction, emergency admissions, overdoses and mortality began to influence prescribing practice," according to a 2016 New Zealand Medical Journal article.
Since 2011, the nationwide rate of oxycodone prescriptions has fallen 26.4 per cent. The Bay's rate has dropped 9.6 per cent. However, the rate is the same as it was in 2013.
Mount Maunganui doctor Tony Farrell said oxycodone was a tightly controlled drug prescribed appropriately in most cases, but said there were likely instances when its use could be tightened up.
"One of the things about oxycodone is it's actually a very effective analgesic ... There are always concerns about medications that can lead to problems like addiction or abuse. Just because there are a lot of prescriptions doesn't mean that's necessarily happening, but there is more chance that it is," Dr Farrell said.
"You have to be a little concerned that some of those prescriptions aren't as good as they could be ... [but] I think we've got a controlled drug situation."
Oxycodone was dispensed at a higher rate than morphine in the Bay; something also matched by no other DHB in the country.
The Faculty of Pain Medicine of the Australian and New Zealand College of Anaesthetists noted six years ago some patients were hesitant to take opioids out of fear of addiction, despite most recipients experiencing no dependence.
"A groundswell of opposition to prescription opioids could be detrimental to the thousands of patients for whom they are effective," said Professor Milton Cohen, FPM's Director of Professional Affairs.
"It would be disastrous for those people who respond well to opioids if this option was
thrown out because of the risks of misuse."
Bay DHB medical director Dr Hugh Lees said the health board would like to see a reduction in the prescribing of oxycodone.
"Best practice tells us that strong opioids, including oxycodone, should primarily be used for managing acute pain, eg immediately after surgery, and only prescribed for short periods in the management of chronic pain."
However, BOPDHB also prescribed strong opioids for six weeks or longer at a higher rate than any other DHB. This rate has increased in each of the last four years, despite limited evidence of its long-term effectiveness for chronic, non-cancer pain, according to the New Zealand Medical Journal.
Prescription opioid abuse was at the point of an epidemic in the United States, according to the Centersfor Disease Control and Prevention. More than 14,000 Americans died in 2014 from overdoses involving prescription opioids, and almost 2 million Americans were addicted. Methadone and oxycodone were the two most overdosed opioids.
However, the prescribing environment in New Zealand was vastly different and more tightly controlled than in the US, said Dr McMinn. He said New Zealand was unlikely to ever get to the level of harm experienced in the US.
"I think the safeguards are greater here compared to the US. It's a less sensationalist story, but I think the structure of healthcare provision here allows for more considered prescribing, which is your strongest safeguard.
"That having been said, many addiction specialists and some pain doctors would be concerned about the rate at which oxycodone has been prescribed without what seems to be adequate consideration around day-to-day safeguards," Dr McMinn said.
"We've become opioid-heavy in our prescribing."
