Health board reviews use of strong drugs

Whanganui District Health Board will analyse where potential improvements can be made following a national commission's findings on the overuse of powerful drugs.

The Health Quality and Safety Commission is calling on district health boards 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 Whanganui District Health Board was about the middle of the list.

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.

Whanganui DHB Allied Health manager Louise Allsopp said the DHB took the commission's findings as an impetus to continue its focus on opioids.

"The information from the commission provides us with the opportunity to see where potential improvements can be made, so that we may provide the best care possible to our patients," she said.

"In terms of dispensed morphine for six or more weeks, the DHB is below average and this is pleasing given the work that has occurred in encouraging doctors to carefully consider the amount of medication prescribed when leaving hospital."

The amount of opioids such as oxycodone prescribed was continuously reviewed to ensure they were used appropriately, Mrs Allsopp said.

"The DHB has reduced oxycodone use by ensuring it is reserved for patients who cannot take other alternatives ...

"Our local audits show that the use of oxycodone within the hospital approximately halved from 2011/12 to 2012/13."

However, opioids continued to be necessary at times, she said. "Each patient is looked at individually. Opioids are a useful adjunct in the treatment of pain in some patients. It is important to take this as context because some patients do need strong opioids to control their pain."

The DHB was also working with the commission on their campaign to reduce the harm from high risk medicines, 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?" 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 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.