Mar 01, 2024

Opioid use in Aussie care homes 30 times higher compared to Japan’s

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The pain medications most commonly used in residential aged care include paracetamol, anti-inflammatory drugs such as ibuprofen, or opioids. [Source: Shutterstock]

A new study has revealed that only 11% of Japanese aged care facility residents are prescribed regular pain medications compared to 74% of Australia’s aged care facility population.

Furthermore, the use of opioid pain medicines in aged care facilities was found to be 30 times higher in Australia.

Opioid use is common among adults aged 65 and older as medicines like morphine and oxycodone are frequently prescribed for chronic pain related to arthritis, urinary tract infections (UTIs), circulatory problems and other health issues. However long-term use of opioids remains controversial and poses risks of drug dependence and severe side effects.

Side effects of opioid use experienced by older people can include: 

  • Nausea and constipation
  • Urine retention
  • Central nervous system effects (sedation, mild cognitive impairment, respiratory depression)
  • Increased sensitivity to pain
  • Cardiovascular and endocrine system effects

The new study led by Monash University’s Centre for Medicine Use and Safety (CMUS) in collaboration with Japan’s Institute for Health Economics and Policy, compared pain medicine use among two samples of Australian and Japanese residents to better understand the pharmacological management of pain in residential aged care.

Qualitative data obtained through focus groups with Australian and Japanese healthcare professionals highlighted the differences in therapeutic goals, painkiller regulations and treatment durations between the two countries.

Research from 2022 to systematically review the prevalence of opioid prescribing, dispensing and administration in Australian aged care facilities found that up to half of the participating residents were dispensed opioids over 12 months. 

Other research observed higher prescription rates of opioids in residential aged care during the first year of the COVID-19 pandemic compared to the year before, particularly more prevalent in rural and regional areas.

The CMUS study’s lead author and pharmacist, Laura Dowd, said these differences may explain the disparities in painkiller use between the respective countries.

“Australian participants described their therapeutic goal was to alleviate pain and reported painkillers were often prescribed on a regular basis, whilst Japanese participants described their therapeutic goal was to minimise impacts of pain on daily activities and reported opioid painkillers were prescribed for short-term durations, corresponding to episodes of pain,” Ms Dowd said.

Senior author and CMUS Research Fellow Dr Amanda Cross said, “This study confirms previous CMUS research that shows up to one-third of Australian residents are prescribed opioid painkiller medicines and highlights key areas where on-site aged care pharmacists could work to support the appropriate use of opioids.”

Dr Shota Hamada from the Institute for Health Economics and Policy in Tokyo said, “Painkillers are one component of an effective pain management strategy. Understanding the different role of painkillers as part of the overall approach to pain management will help the safe and effective painkiller use.”

In June 2020, the Federal Government made several changes to regulations that govern the prescription and supply of opioids, however, changes to medication regulations alone are a one-dimensional strategy to reduce opioid use.

Just last year The Royal Australian College of General Practitioners (RACGP) Chair of Specific Interest Addiction Medicine, Doctor Hester Wilson, said the medical field needs to move away from considering opioids as a long-term treatment for older people with chronic pain as they are often on multiple medications that could react badly.

“Not everybody is the same, but many of my older patients are very trusting and if I give them a medication they just take it so for older people living in the community, it’s really important to take a look at your medicines, have conversations with your GP and pharmacists and look at what risks are associated with your medicines.”

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  1. We must do better with the CARE we provide in Australia. Having worked previously in residential aged care I understand that there is a different view of what “quality of life” is. I am a palliative care worker helping people live safely, independently and well at home (no matter what their age, medical condition/s or circumstances) within their own established community and supports around them.

    I see miracles happen every day. All because of the strength of who people are as human beings.

    The work I do with dementia clients and clients post-stroke has led to me going back to Uni to study neuroscience as the “miracles” I have seen actually have ground breaking neuroscience to support them and our understanding of how the brain works has greatly evolved since opiates were first developed as a prescription drug. (If we knew then, what we know now they would never be approved!)

    Prescribing a pill has never been the answer and never will be. I live with PTSD and chronic pain myself. I have also had to take opioids for extreme pain post surgery. Pain management and the “discussion” that gets had “around it” needs to start focussing on the life goals of the person (person-centric) and not just seen as something to “give them to assist with pain”. There are times where the drugs are absolutely necessary. Make no mistake about that!

    I wouldn’t be able to walk had I not been able to use them during my physical therapy post hip replacement and spinal ablation.

    But medicating people to stay in bed all day is not contributing in any way to their “quality” of life. Perhaps their longevity, I don’t know. I recall clients in residential aged care that were old and very sick but were doing the best with what they still had. I also saw those that were medicated to the point of being “anaesthetised“ and still suffering.

    From a mental health and neuroscientific perspective we KNOW opiates lose their effectiveness and actually don’t even work longer term.

    Japan “sounds like” they have a “focus on CARE” that we should be aspiring to!

    We need more community input and more neuroscientific research in this area. Not a “new drug” ….

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