Palliative care group opposes opioid prescribing curbs

End-of-life care

By Tessa Hoffman

19 Jun 2018

Palliative medicine clinicians are warning against a regulatory move to curtail GPs’ powers to prescribe opioids.

The controversial idea to limit prescribing of Schedule 8 opioids to specialist/authority prescribing or to “certain classes of medical practitioners” was put forward in a TGA consultation paper released in January on options for a regulatory response to the misuse of prescription strong s8 opioids.

But the Australian and New Zealand Society of Palliative Medicine (ANZSPM) has added its voice to the growing chorus of doctors’ groups warning that the move could hurt patients in regional and rural Australia where specialists are thin on the ground.

In its submission, the ANZSPM, which represents over 350 doctors including haematologists, oncologists and GPs, acknowledged that specialist input “is often warranted” when it comes to opioid prescribing.

However, the proposals to curtail GP prescribing could lead to “significant disparities of access” where patients lack access to palliative medicine and pain specialists.

“Flexibility is needed to ensure palliative care patients who no longer are able to attend ambulatory services as their condition deteriorates can continue on their medications under supervision of their primary care physicians, if community specialist access is limited or clinical reassessment at specialist level is not required,” the society said.

The TGA consultation document also flags mandatory pack sizes for acute pain (3 day maximum supply) and chronic pain due to malignancy (28-days) as options to reduce opioid misuse and dependence.

While ANZSPM supported pack size options, it warned that any changes must not disadvantage people with non-malignant life-limiting conditions who need opioids.

A requirement for opioid medication packs to carry safety warnings highlighting the risk of dependence and lack of efficacy for long-term non-cancer pain, was also suggested in the TGA proposals.

The society said while it “supports accurate consumer information” this should not serve as a deterrent to those who need it.

“Many patients with cancer pain have misconceptions and concerns about opioids, and consumer information should not indirectly lead to barriers to the adequate management of pain in the palliative setting if an opioid is indicated.”

The Australian Rheumatology Association has backed the idea for specialist oversight over GP prescribing for non-cancer pain, stressing it would not support any plan that restricted access to opioids for cancer or palliative care patients.

The TGA has now closed submissions on the proposal and says it will develop recommendations based on the feedback it has received from interested parties.

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