Study finds oxycodone consumption cut in half after prescribing guidelines change

The amount of oxycodone used in Australia has almost halved since national changes to packaging and prescribing rules were introduced, a new study detecting levels of the opioid in wastewater has found.

The study collected data from 50% of Australia's population between April 2017 and April 2023, analysing 6,900 samples from more than 50 wastewater treatment plants.

Rory Verhagen from the University of Queensland found that oxycodone consumption fell by 45% between 2019 and 2020.

“Oxycodone use fell nationally from 120 milligrams per 1,000 people per day to 65 milligrams per 1,000 people per day between August 2019 and December 2020,” Dr. Verhagen said.

“Consumption has become more stable from 2021 to 2023.”

Dr Verhagen said the study also monitored fentanyl and heroin and found that fentanyl consumption showed similar trends to oxycodone, while heroin fluctuated over the same period.

The drop in oxycodone consumption coincides with changes aimed at reducing prescriptions, including new prescribing guidelines, reducing package sizes from 20 to 10 tablets and adding warnings in 2020.

“While we cannot directly link this decrease to any single policy change, it is likely that a combination of these changes led to a national decrease in oxycodone use in the community,” Dr. Verhagen said.

He said community awareness, including reports in medical journals and in the news about the ongoing opioid crisis in the United States, also likely played a role.

“People who may have been prescribed oxycodone are following the news and are aware of the possible risks, so they may not take the oxycodone,” he said.

The decline in consumption is in stark contrast to the significant increase recorded between 2017 and 2020, when consumption increased from 78 mg per 1,000 people per day to 120 mg per day.

Oxycodone is a Schedule 8 controlled drug in Australia and is used as an opioid to treat acute and chronic pain but carries a risk of addiction and death from overdose, especially if used incorrectly.

High-risk drugs

Opioids are the most common drug associated with unintentional drug-related deaths, accounting for half of the 926 deaths in 2022, according to the latest annual overdose report compiled by the Pennington Institute.

The report found that since 2018, the number of opioid-related unintentional deaths has increased by 15.9%, while the number of patients receiving opioid prescriptions has decreased by 13.5% during the same period.

The Australian Institute of Health and Welfare estimated that around 2% of Australians will report using prescription opioids illegally or for non-medical purposes in 2022-23, and around 1% will report using heroin.

Hester Wilson, addiction expert and chair of the RACGP addiction special interest group, said it was good to see an overall drop in consumption.

Dr Wilson said that while opiates do have benefits, they are high-risk drugs that can cause serious side effects, including addiction.

“For some people, their opioid use begins to spiral out of control four to seven days after they start,” she says.

“Patients begin to realize they need more and are craving more, but often don't realize it until their symptoms become severe.”

Dr Wilson said some people have no problem stopping taking medication, but treatment requires ongoing review and making sure the medication is still benefiting the patient.

“We reassess and review to make sure they're meeting their goals of functioning better, living, working, mowing the lawn and playing with their kids,” she said.

“For patients who continue to be prescribed opiates long term, we would be more willing to lower the dosage and explore alternatives, if that is appropriate.”

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