Managing prescription misuse

Bendigo pharmacist and lecturer, Pene Wood, weighs in on the debate around opiod management

Bendigo pharmacist, Pene Wood, knows almost every study and statistic on prescription misuse. “Last year in Victoria, more people died from prescription overdose than in car accidents or from illicit drugs like heroin,” she said. “In Bendigo between 2009 and 2015, 49 of 58 overdose deaths involved a pharmaceutical drug.” And the statistics keep coming. In August, the National Drug and Alcohol Research Centre found that the rate of accidental deaths due to opioids has more than doubled among Australians aged 35 to 44 since 2007, with more than two thirds of deaths due to pharmaceutical opioids rather than heroin.

The problem is reaching epidemic proportions, and Wood is determined to do something about it. A qualified pharmacist – she was among the first cohort of students to graduate with a La Trobe Bachelor of Pharmacy degree – Wood has over ten years’ experience working in community pharmacies. Today she is a lecturer in Pharmacy and Applied Science, an Opioid Management Clinical Advisor with Western Victoria Primary Health Network, and is half way through completing her PhD on opioid management.

Potential for harm

“Many people aren’t aware of the dangers of prescription medications and the potential for harm,” she said. “Patients become iatrogenically dependent because they are using medication for pain and find that, ‘Oh, it also helped me deal with the crazy life I can’t handle.’ And they keep taking it.”

So why are opioids like codeine so addictive? “Codeine gets converted to morphine in the body,” Wood explains. “About 30 milligrams of codeine equates to about one milligram of morphine. Some people metabolise codeine very quickly, and when they do, it’s like getting a hit of morphine. Some people don’t metabolise it at all, so it doesn’t work. Others are normal metabolisers, so they receive benefits from it as a painkiller. It’s quite variable, and patients won’t know what type of metaboliser they are other than by the effect.”

Education is key

Wood believes that providing health professionals with further education on the management of pharmaceutical opioids is key. In conjunction with the Pharmacy Guild, she has developed pathways to help pharmacists identify those people who have a suspected dependency, and what level of intervention is needed. Wood is also a strong advocate for real-time prescription monitoring, to be introduced in Victoria in 2018. “Monitoring will identify people at risk who may be visiting several doctors for opioid prescriptions,” she said.

“The stigma around addiction still exists in our community,” Wood added. “We need to develop programs that identify dependent patients and then provide treatment options. Social connectedness and support is an important part of the recovery process. We need to offer that consistently and compassionately to those who need it.”

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