How Opioid Withdrawal Triggered One Chronic Pain Sufferer’s Mental Health Battle

The Therapeutic Goods Administration also sent messages to healthcare professionals about best prescribing practices and sent letters to GPS who were among the top 20% of opioid prescribers. The crackdown has led to a sharp drop in opioid prescriptions. Between 2016 and 2021, opioid medication dispensing rates were reduced by 18 percentwith a 30% reduction in the overall volume of opioid medicines dispensed.

And in September last year, the National Board of Health and Medical Research approved evidence-based clinical practice guidelines for removing patients from opioids.

But Pain Australia chief executive Giulia Jones said there was still a place for the use of opioids, provided they were prescribed “with care and common sense”, and shared her concerns about regulations limiting painkillers. “There is a large group of people who are very distressed by the changes that have happened,” she said.

It has been shown that opioids reduce chronic pain not linked to cancer, although slightly. The Therapeutics Goods Administration recommends that opioids be used only in “exceptional circumstances” or for non-cancer pain relief “as needed.”

University of Sydney School of Pharmacy associate professor Danijela Gnjidic, who helped develop the guidelines, said they provide a pathway to stopping or reducing opioids from when they are prescribed, with regular examinations.

“It’s a person-centered approach to help someone reduce their opioids if they want to and to empower patients,” she said. “These guidelines are not there to say ‘stop opioids’, they are there to help clinicians, GPs and patients work together to identify the most appropriate approach to reducing opioid use over time. time.”

Pharmaceutical opioids are responsible for more deaths and hospitalizations than heroin or methadone. In 2016, more than half of people using painkillers and opioids for non-medical purposes bought them over-the-counter at the pharmacy, while one in five obtained them with a doctor’s prescription.

“These guidelines are not there to say ‘stop opioids’, they are there to help clinicians, GPs and patients… to [reduce] opioid consumption.

Danijela Gnjidic, Associate Professor at the University of Sydney School of Pharmacy.

The dangers of opioids are not well known to patients, with a TGA Report 2020 finding that less than half of all opioid users knew they were taking an opioid medication, while only 17% said they were not dependent on their medication.

People with opioid addiction have higher rates of suicide and self-harm than general population, study finds nearly one in 10 people with the disorder presented to hospital for self-harm in New South Wales.

But those who suffer from chronic pain are also at least twice as likely to report suicidal behaviors and may face a higher risk of self-harm if they stop opioids.

US data have shown that stopping opioid treatment among veterans is associated with increased risk of death from overdose or suicideespecially among long-term users.

Australia has yet to collect data on the link between stopping opioid prescriptions, overdoses and mental health crises. However, Monash Addiction Research Center deputy director Professor Suzanne Nielsen said the international data underlined the need to “proceed with caution”.

Nielsen also said a “worrying” emerging trend following the reassessment of opioid drug use was the rise in heroin-related mortality. “There is evidence to suggest that we may have moved some people away from the medical system and onto illicit opioids,” she said.

Heroin use increased by 10 percent between 2021 and 2022 and is now the second most consumed illicit drug after methylamphetamine.

Nielson ‘hopes’ the new guidelines will have good results as they emphasize the importance of collaboration with patients and can help identify patients with opioid use disorders and refer them to specialist treatment .

During the last fiscal year, approximately 131,000 Australians sought treatment for alcohol and drug addiction. “There have been estimates that we need to double the number of treatment places in Australia so everyone who needs treatment can access it,” Nielson said.

Neen Monty was first prescribed opioids eight years ago for a mixed connective tissue disease, arthritis and ankylosing spondylitis, a condition of the spine.

Loading

After surgery in 2020, she suggested to her GP that she reduce her opioids, reducing her dose from 40 milligrams to 10. But her pain returned and she asked to go back to her original dose. Monty said his GP refused and planned to take him off the opioids altogether.

“I tried all these alternative drugs but for me they were horrible,” she said. The drugs caused weight gain and fatigue, and her pain remained at elevated levels.

Monty, who lives in Canberra where she runs two small businesses and cares for her son, is back on 20 milligrams and combines opioids with daily exercise, meditation and hot and cold compresses.

“I’ve done all the pain education…but if you take my painkillers away, there’s really nothing I can do but lay in bed and feel bad. It’s not a life,” she said. “When you know there’s a treatment that can reduce that pain and you can have a life that people won’t give it to you…it’s torture.”

Doctors are encouraged to offer alternatives when withdrawing opioids from patients, but Jones said that hasn’t happened for a number of users. “Some of these people still haven’t found a replacement option or an alternative.”

Loading

A 2022 survey conducted by Pain Australia found that 59.6% of respondents reported difficulty accessing treatment options for managing their pain. The organization receives research grants from pharmaceutical companies. Forty-three percent said their healthcare professional did not offer them alternative treatment or support to manage their pain.

Between 2016 and 2018, the median wait time for persistent pain service was 60 daysalthough some clinics had wait times of up to three years.

Pain Australia supports multidisciplinary pain management, consisting of psychological training, physical movement – ​​and, for some, medication. The intention is not to take strong painkillers every day, Jones said, but to have them available during flare-ups. “The consumer of pain is reviled. You wouldn’t wish chronic pain on your worst enemy, but we just dismiss it and pretend people are exaggerating.

The life line is at 13 11 14.

The Morning Edition newsletter is our guide to the most important and interesting stories, analysis and ideas of the day. register here.