Painkillers under scrutiny

Lakes DHB is reviewing its use of highly addictive painkillers. Photo / File

The Lakes District Health Board has been reviewing its use of highly addictive painkillers in line with a national commission's call for alternative treatments to be considered.

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

The use of opioids, which resemble morphine or other opiates in their pharmacological effects, by the Lakes DHB was about the middle of the list, with many other districts above and below its rate of prescription.

The figures came from the commission's Atlas of Healthcare Variation, a 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 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.

Lakes DHB spokeswoman Charlotte Foley said the DHB regularly interviewed patients about pain relief and side effects.

"Lakes DHB is currently participating in the Safe Use of Opioids national collaborative and has chosen to work with the orthopaedic inpatient cohort of patients," she said.

"We are also participating in the Partners in Care programme for this project and so we are actively involving patients in the process of understanding any current gaps."

Ms Foley, the Safe Use of Opiods project leader, said the DHB was also testing its data collection methods so it could measure harm arising from the use of opioids.

"It is important to balance the need to keep our patients comfortable with well managed pain against the potential harmful side effects of that pain relief," she said. "Lakes DHB will be examining the best way to maintain this balance ..."

The DHB would measure whether alternative analgesia options had been offered or were clinically appropriate, she 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 oversedation. "The question is, do we need to use strong opioids as much as we do?" he 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 women were dispensed significantly more 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.