New national standards aim to change doctors’ prescribing habits for hospital patients with pain when they’re discharged home.
Hospital patients are often given strong, opioid pain medicines when discharged home after surgery and other treatments. This can sometimes lead to long-term use and dependence, opens in a new window.
New national standards, opens in a new window, released today by the Australian Commission on Safety and Quality in Health Care, opens in a new window, aim to reduce prescribing that increases the risk of dependence.
The standards encourage hospital doctors to consider prescribing alternative pain relief such as paracetamol and ibuprofen for mild to moderate pain where possible.
When stronger pain relief is required – and medicines such as oxycodone, morphine, fentanyl, tramadol and codeine are prescribed – the standards recommend discharging patients with up to seven days’ supply, depending on their circumstances.
So what are the risks of dependence? And how can clinicians ensure pain is adequately managed?
Acute pain isn’t just unpleasant to experience. Pain causes the body to enter a stress response, opens in a new window. This can have wide-ranging effects on the body, from raising your heart rate, to reducing the functioning of your immune system.
Uncontrolled pain in hospital may lead to poorer patient outcomes, opens in a new window: people in pain take longer to recover and may experience longer hospital stays.
Uncontrolled acute (short-term) pain may even progress to chronic pain, opens in a new window, which is much harder to manage and can have significant impacts on a person’s quality of life.
Treating pain is also ethical, and access to adequate pain management has been recognised as a fundamental human right, opens in a new window.
Patients have a right to adequate pain management. Shutterstock, opens in a new window
There are several reasons why people may experience pain in hospital, including injury, illness or surgery. Internationally, 84% of hospital patients, opens in a new window report experiencing pain. And up to three-quarters, opens in a new window of patients experience moderate to severe pain after surgery.
Opioid medicines are commonly used to manage pain in hospital. But with hospitals encouraged to get patients home earlier, many people may still be experiencing pain when they’re discharged. So opioids are also often prescribed on discharge.
Although opioids are effective in treating many types of pain, they are considered “high risk medicines”. They can cause multiple unwanted effects, opens in a new window which range in severity, opens in a new window from nausea and constipation, to life-threatening breathing problems and loss of consciousness.
Prescription opioid use has increased internationally over the past 30 years. In Australia, we’ve seen a 15-fold increase, opens in a new window in opioid prescriptions dispensed on the Pharmaceutical Benefits Scheme between 1995 and 2015.
Over the same time period, harms, opens in a new window from opioids, opens in a new window have also risen, opens in a new window. Between 2001 and 2012, deaths from pharmaceutical opioid overdoses in Australia rose from 21.9 per million population to 36.2 per million population, opens in a new window: an increase of 6% per year.
Prescription opioids are now involved in more deaths than illicit opioids, opens in a new window such as heroin.
To address these issues, government bodies have introduced strategies, opens in a new window to improve the safety, opens in a new window of opioid use. Although many focus on addressing opioid use in the community, opioids are also commonly used in acute care settings such as hospitals.
Good pain management aims to ensure pain is well managed while making sure the risk of any unwanted effects is low.
One of the risks is that short-term opioid use may become long-term opioid use. Studies have found that among people who receive opioids after surgery, opens in a new window, 1-10% are still using, opens in a new window them up to one year later, opens in a new window.
Existing opioid treatment guidelines, opens in a new window recommend doctors prescribe the lowest dose, opens in a new window of opioids needed for sufficient pain relief, for the shortest amount of time possible.
However, this does not always occur in practice. There is wide variation in what patients are prescribed at discharge, even within the same hospital or surgical unit, opens in a new window.
Good pain management means balancing the risks and benefits of medicines. Shutterstock, opens in a new window
Clinical care standards are a set of quality statements written by an expert writing group for consistent and high-quality health care. They aren’t rules; they’re guiding principles that inform patients and clinicians about “best practice” for a clinical area.
In many ways, the new opioid standards aren’t new – they’re consistent with current guidelines and research. However, they provide “indicators” for health care organisations to measure their performance against. Given ongoing issues with opioids, indicators may provide important feedback on how opioids are being used.
Building on regulatory changes implemented in 2020, opens in a new window, such as smaller pack sizes when filling prescriptions from community pharmacies, these new standards, opens in a new window come at a good time and will play an important role in ensuring opioids and other analgesic medicines are used appropriately and safely for short-term pain.
However, they don’t cover chronic pain, cancer pain, palliative care, or patients with opioid dependence.
It’s now up to clinicians to ensure they’re implemented, with patients given adequate pain relief and prescribed the lowest dose for the shortest time possible.
Ria Hopkins, opens in a new window, PhD Candidate, National Drug and Alcohol Research Centre, UNSW Sydney, opens in a new window and Natasa Gisev, opens in a new window, Clinical pharmacist and Scientia Senior Lecturer at the National Drug and Alcohol Research Centre, UNSW Sydney, opens in a new window
This article is republished from The Conversation, opens in a new window under a Creative Commons license. Read the original article, opens in a new window.