Bay's use of strong painkillers reviewed

Doctors are trying to reduce use of a highly addictive painkiller.

Hawke's Bay District Health Board has been working on reducing the use of a highly addictive painkiller, as a national commission shines a light on overuse of powerful drugs.

The Health Quality and Safety Commission is calling on DHBs to examine their use of strong painkillers after finding prescription rates were three times higher in some areas than others.

The use of opioids by the Hawke's Bay DHB was about the middle of the list, with many other districts above and below the rate of prescription.

The figures came from the commission's Atlas of Healthcare Variation, a new database of health services and outcomes. The doses were dispensed from community pharmacies in 2013, and did not include drugs given in hospitals.

However, nearly half of those given the strong opioids had been treated at a public hospital in the week before.

Strong opioids include methadone, morphine, fentanyl and oxycodone. Commonly used weak opioids include codeine, tramadol and dihydrocodeine.

Hawke's Bay DHB chief pharmacist Billy Allan said the DHB had a particular focus on reducing prescriptions of the opioid oxycodone because of its highly addictive properties.

"This work began in 2011 and has seen oxycodone dispensing in primary care drop from over 17,000 items in 2011 to just over 10,000 items by December 2014," he said.

"In hospital, its usage had almost dropped to less than 800 items in 2014 from 5500 items in 2009."

Mr Allan said opioids were useful painkillers which were necessary in acute situations. "What is important is getting the dosage right and understanding the needs and individual aspects of each patient before they are prescribed ...

"What is important from the work the Health Quality and Safety Commission is doing is to highlight the use of opioids, and create a better understanding of some of their more addictive properties and the importance of getting the dosage for individual patients right."

The DHB would continue to work with prescribers to understand the effects of opioids and other drug alternatives, Mr Allan said.

Dr Alan Davis, chairman of the commission's expert advisory group, said opioids were effective in managing pain but were also the class of medicine most often implicated in patient harm - including addiction or over-sedation.

"The question is, do we need to use strong opioids as much as we do?" Dr Davis said.

Wairarapa had the highest rate of strong opioid use in the country, followed by Nelson Marlborough, Bay of Plenty and Northland. The lowest rates were in Capital and Coast, Auckland and Canterbury.

The commission also found that women were dispensed significantly more strong and weak opioid drugs.

Use increased with age, and people of European ethnicity had two to four times higher use of strong opioids than Maori, Pacific or Asian people.NZME.