The Concerning Nature of Opioids – Research Round-Up

Research Roundup: The Concerning Nature of Opioids

The following article examines recent published peer-reviewed journal articles and our own research at SPP to discuss the issue of prescription drug abuse and treatment.

Research indicates an increase in individuals prescribed medication.

In a December 2015 published research, Zhang et al. (Zhang, F., Mamtani, R., Scott, F. I., Goldberg, D. S., Haynes, K., and Lewis, J. D. (2015) Increasing use of prescription drugs in the United Kingdom. Pharmacoepidemiol Drug Saf, doi: 10.1002/pds.3947.) surveyed the UK population finding that pharmaceutical medication increases from 1999-2012 were significant.

They found:

  • A 5% increase of individuals prescribed at least one medication (from 64-69%)
  • An increase from 14%-17.5% of individuals prescribed 5-9 medications
  • An increase of nearly 5% (from 4.7-9.6%) of individuals prescribed 10 or more
  • Research indicates a significant number of individuals struggling with prescription or over-the-counter medication abuse presenting for treatment

In a recent month’s analysis of South Pacific Private’s client discharges (24 November to 23 December 2015) we found the following:

  • 84% of all clients presented to SPP to address issues related to substance abuse
  • 66% of all clients presenting to SPP were dealing with Alcohol abuse
  • 19% of all clients presenting to SPP were dealing with over-the-counter or prescription drug abuse
  • 64% of the OTC or Prescription drug abusers leave SPP on antidepressant or anti-anxiety medication indicating a dual diagnosis
  • The products SPP clients claiming to abuse included:  Codiene, Ritalin, Valium, Xanax, Mersyndol, Endone & Oxycodone.

In a recent article in the Australian Prescriber, Danielle Wood (Wood, D. (2015). Drug diversion. Australian Prescriber, 38(5), 164–166.) states that the most commonly diverted drugs include:

All Benzodiazepines, all opiates, among stimulants dexamphetamine, pseudoephedrine and methylphenidate; among antipsychotics olanzapine and quetiapine; among anaesthetics ketamine and propofol and among GABA agonists gabapentin and pregabalin.

Wood goes on to discuss the concerning nature of opioids from which a percentage of the prescribed drug is diverted.  Her concern is the increase of dispensing from 500,000 annually in 1992 to 7.5 million dispenses in 2012. The 80mg Oxycodone sales have dropped dramatically since the introduction to the abuse-deterrent formula in 2014.  Wood concludes that prevention strategies, drug monitoring and training are tools for overcoming this problem in Australia.

Research indicates concerns about commonly used medication in the mental health setting.

Two recent articles published in Australia highlight the need for care when prescribing two medications often found in the mental health setting, Valium and Seroquel.

Brett, J., & Murnion, B. (2015). Management of benzodiazepine misuse and dependence. Australian Prescriber, 38(5), 152–155.

Despite a modest decrease in the annual number of benzodiazepine prescriptions dispensed, the current level of prescribing probably represents significant overuse. Over the last 20 years the quantity of benzodiazepines on each prescription has increased. Alprazolam became the second most popular drug, increasing more than eightfold. Of particular concern are the patients who have been using benzodiazepines for more than six months. There are few indications for long-term therapy and they are generally controversial.

Brett, J. (2015). Concerns about quetiapine. Australian Prescriber, 38(3), 95–97.

There is a high level of evidence to support the approved indications of quetiapine, but it is being increasingly used off label. Often, clinicians are faced with difficult decisions about prescribing antipsychotics for off-label indications when dealing with distressed patients and inadequate resources for psychological treatments and other support. However, there is growing concern from within the medical community and regulatory bodies regarding the potential harm from prescribing antipsychotics off-label, particularly immediate-release quetiapine.