'We're the ones creating problems for GPs': Hospital acts on addictive drug

When the pharmacy at St Vincent's Hospital alerted pain specialist Dr Jennifer Stevens to the "steep" year-on-year increases in the amount of opioid-based painkillers being prescribed to patients on discharge, she knew something had to change.

To cut the prescription rates, she started holding educational sessions for junior doctors, teaching them about the highly addictive properties of Oxycodone that could ensnare patients into a dangerous cycle of addiction. It failed to make a dent.

She changed strategies, making it personal by showing each doctor the "enormous" difference in the amount they were prescribing compared to their counterpart in the same ward five years prior.

"Instead of saying 'there's a problem', we said, 'this is your problem and I'm going to measure you and watch your performance'," Dr Stevens said.

"Within a month, we saw the number of Oxycodone tablets being dispensed drop by 50 per cent."

The program's results are critical at a time when health authorities worldwide are grappling with soaring rates of opioid addiction and deadly overdoses. In Australia, the majority of opioid overdose deaths are now related to prescription painkillers rather than heroin.

St Vincent's innovative program is likely to have a broader impact because while the bulk of prescriptions are made by GPs, a patient's first exposure to opioids usually occurs in hospital after surgery.

"So we're the ones creating the problems for the GPs, because it's the unseen patient, they leave the hospital and the deaths are not in front of us," she said.

"We're five or six years behind the US [where President Donald Trump recently declared the opioid epidemic a "national emergency"] and it makes you very motivated to not head down the same path any further."

In a further improvement, Dr Stevens devised an "inappropriateness" tool that junior doctors used to determine whether prescribing opioids on discharge was reasonable based on what the patient had taken in the last 48 hours.

The number of patients being inappropriately supplied with Oxycodone on discharge fell by 62 per cent.

Dr Ron Murambi, now a neurosurgery registrar, said being confronted as a junior doctor with personal numbers on opioid prescriptions prompted him to change.

"I became very conscious when talking to patients in pre-admission to mention it beforehand so that they can be prepared and they'll be more receptive," he said.

"I now talk to new interns about when to prescribe opioids so we maintain the pattern."

Dr Stevens said the overall increase in prescriptions in Australia reflected a generational change because Oxycodone didn't interact with many drugs and was seen as being quite pure.

A new study involving more than 1000 patients who didn't use opioids before surgery at St Vincent's Private Hospital has found that 25 per cent of back surgery patients and 15 per cent of joint replacement patients continued to use opioids 90 days after their operation.

"Before the surgery they were managing the pain, but afterwards they were using quite dangerous methods to manage their pain and that was a shock and galvanised us to work harder to educate doctors," said Dr Stevens, one of the authors.

Bee Mohamed, chief executive of ScriptWise, a non-profit group aiming to reduce prescription medication misuse, said this was the first time she had heard of such an intervention and urged other hospitals to implement a similar program.

"It's quite common that they get sent home from hospitals with packets of opioid painkillers and there's no follow-up and sometimes that's how the journey to addiction starts," she said.

"Any start is a good start. Fewer patients leaving hospital with these means we could end up with a better outcome."

The story 'We're the ones creating problems for GPs': Hospital acts on addictive drug first appeared on The Sydney Morning Herald.