Wairarapa opiate dose rate leads NZ

OPIATE USE: Questions have been raised over whether strong painkillers are being appropriately prescribed to people in Wairarapa. PHOTO/FILE

A Wairarapa health group will look at the way powerful painkillers are prescribed after the region was found to have the country's highest dispensing rates.

Last month, the Health Quality and Safety Commission released data on opioid dispensing rates in 2013 from community pharmacies.

It did not include drugs given in hospitals but nearly half of those given strong opioids, such as methadone, morphine, fentanyl and oxycodone, had been treated at a public hospital the week before.

Tony Becker, GP clinical lead for Wairarapa and clinical director of Masterton Medical, said their prescription rate data and the dispensing data did not match up.

"We can't reconcile the figures that we have in terms of prescription rates," Dr Becker said.

"We don't know if there is a problem. We can't compare ourselves to any other areas without knowing their prescribing rates."

The best way to deal with the issue was to examine it further.

"We are interested in getting a primary and secondary [health] group to look at whether opiates are being prescribed appropriately."

Some unusual figures had been included in the data, he said.

For example, there were only 90 people on the methadone programme but 21,000 dispenses of methadone.

He expected the amount of palliative care in Wairarapa to affect some of the morphine dispensing rate figures.

"We will have a slightly higher opiate use."

The figures show during 2013 almost 900 Wairarapa people were dispensed morphine once or more, 407 people dispensed oxycodone, and 111 fentanyl.

Opioids are highly effective in managing pain but also the class of medicine most commonly implicated in patient harm.

The commission's opioid expert advisory group chairman, Alan Davis, said the wide variation between district health boards' dispensing rates was a cue for clinicians to closely look at how they prescribed the medications.

"It may be a patient who's had an operation doesn't actually need strong opioids once they leave hospital but they've been given them anyway," Dr Davis said.

"It may be appropriate they change at that stage to weaker-strength painkillers.

"Maybe they could get by without painkillers at all, there might be lifestyle strategies to help them manage discomfort.

"Of course, it may also be the prescription is completely appropriate as it is," he said.