A new study published in the International Journal of Drug Policy has shown that while Australians are using fewer prescription opioids (medications like oxycodone, morphine and tramadol), there has been a big increase in private prescriptions for these drugs.
The study, conducted by researchers from the National Drug & Alcohol Research Centre (NDARC) and the Medicines Intelligence Centre of Research Excellence at UNSW Sydney, revealed a 33% reduction in Pharmaceutical Benefits Scheme (PBS) opioid dispensing claims, primarily for long-acting formulations.
This decline follows the implementation of government measures aimed at curbing opioid use.
However, despite these efforts, private prescriptions for opioids rose by 55%, offsetting around a quarter of the PBS reductions.
“While Australia has reduced its overall consumption of opioid analgesics, our findings indicate a significant rise in private prescriptions, which come with higher out-of-pocket costs for people in pain,” lead author and pharmacoepidemiologist Kendal Chidwick said.
“Reasons for the increase in private market use may include accessing opioids not subsidised under the PBS, or efforts to avoid the PBS restrictions altogether.”
In recent years, Australia has adopted a range of measures to reduce opioid use — such as introducing smaller pack sizes, restrictions on repeat scripts, and real-time prescription monitoring — with the aim of halving opioid-related harms over the five years to 2025.
Government data show that use of PBS-subsidised opioid analgesics has been declining since 2018 — however, these statistics do not capture private scripts or medicines supplied to public hospital inpatients.
To get a clearer picture of population-level trends in prescription opioid use, the researchers used data from IQVIA Inc, which collects information on medicine sales to pharmacies, hospitals and other healthcare settings by pharmaceutical wholesalers and manufacturers.
Senior author and NDARC Research Director, Scientia Professor Louisa Degenhardt says the study provides “critical information to support quality use of these prescription medicines and reduce patient harms”.
“Combining multiple data sources helped us to shine a light on trends in private dispensing of opioids, where the patient pays the full cost without subsidy — information that is not captured in standard PBS datasets,” Professor Degenhardt said.
The analysis is also the first to show that tapentadol has replaced oxycodone as the most commonly prescribed opioid in Australia.
“Preferencing tapentadol for postoperative pain, due to perceived benefits, may be contributing to its increasing use despite limited evidence on the comparative safety of tapentadol and oxycodone post-surgery,” Ms Chidwick said.
But she adds that the number of Australians initiating PBS-subsidised tapentadol had been reducing and “may stabilise as the market matures”.
The study relied on medicine sales data to estimate private market trends, which does not provide detailed information on individual patterns of opioid use.
Despite these limitations, the findings provide critical insights into how policy measures influence opioid use and highlight areas for further action to ensure equitable and effective pain management for Australians.
For pharmacists, the study underscores the importance of real-time prescription monitoring and patient education to support the safe and appropriate use of opioid analgesics
