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New toolkit at Brisbane hospital reduces pain of opioid prescriptions

“In August 2016, around 5 per cent of patients in the emergency department were going home with a prescription for oxycodone,” she said.

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“The thing that really stood out for us was that those patients were all going home with a box of 20 – we wanted to see whether patients really needed that many tablets.”

Ms Pattullo said the goal was to create a framework for doctors and other hospital staff working in the emergency department to help bring non-drug-related pain-management strategies into play instead of relying on opioids.

She said the program had been such a success that staff at Caboolture Hospital had requested it be installed there, and it was being introduced at other hospitals in the Metro North Hospital and Health Service area.

Importantly, the toolkit was not a one-size-fits-all approach, Ms Pattullo said, and had a lot of flexibility built in by design.

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“It’s a recipe, rather than an intervention – it can be adapted to circumstances. What worked in our emergency department won’t necessarily work in other emergency departments,” she said.

“So I help different sites adapt what’s in the toolkit to their local setting and they go from there.”

There has been a concerted push within the medical community in Australia as well as in government at a state and federal level to scale back the use of opioids to prevent overdoses and other health risks.

However, caution has been raised that a sudden reduction in the use of opioid painkillers could drive sufferers of chronic pain onto illicit drugs or leave them stranded and unable to manage their pain.

The Royal Australian College of General Practitioners has welcomed the RBWH’s moves to limit opioid use, but cautioned more broadly against not providing appropriate pain management.

“We are worried about the pendulum swinging too far the other way – one of the concerns has recently been, for example, patients who are dying or in palliative care,” RACGP president Dr Harry Nespolon said.

“The last thing we want to see is doctors not giving them appropriate pain management because they’re worried about overprescribing.”

Patient advocacy group Pain Australia welcomed the toolkit but chief executive Carol Bennett said there was a problem of people with chronic pain being left without options once opioids were taken out of the picture.

“Opioids should not be used for chronic pain management but the problem we have is that there are 3.2 million Australians who live with chronic pain conditions,” Ms Bennett said.

“What we don’t have are the solutions, and the treatments which allow people to manage chronic pain outside of medications.”

Ms Pattullo said she hoped the toolkit they had developed could help bridge that gap.

“The idea is by focusing on good pain management we can get the balance right for individual patients, and avoid both under and overprescribing opioids,” she said.

The toolkit development was funded by the Emergency Medicine Foundation, which supports evidence-based emergency medicine research.

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