Ep 51 and 52 of Pomegranate Health published in September 2019. Listen via any podcasting app or stream directly Part 1 and Part 2

The dramatic headlines about the opioid crisis are all-too familiar by now. Australia and New Zealand have followed the lead of the US, and seen a fourfold increase in opioid use over the last thirty years. Most of this prescribing has been for chronic non-cancer pain, but systematic reviews will tell you that that there are no decent trials that would warrant use for this indication.

In this podcast we’ll discuss some of the latest studies that have actually followed pain patients long-term and provided evidence against the efficacy of chronic opioid use. Addiction medicine specialist Professor Adrian Reynolds talks about how to identify patients that have developed dependence on or addiction to opioids and how to wean them off this medication. And pain medicine specialist Chris Hayes describes an alternative approach to therapy, that involves breaking maladaptive pain associations in the nervous system.

In Part 2 we look at the influence of culture, regulation and marketing on opioid prescribing for chronic non-cancer pain. First we ask which are the prescription opioids most commonly leading to dependence and why are they prescribed. Then we discuss the mixed messages that prescribers are getting from guidelines and pharmaceutical regulation. Ever-relaxing indications for pharmaceutical subsidies can nudge prescribing behaviour in the wrong direction.

Tasmania was for many years the worst performer on measures of opioid use and harm, but this all began to turn around from 2006. Addiction medicine specialist Professor Adrian Reynolds explains how education, regulation and real-time prescription monitoring were brought together in that state.

Finally, an undeniable influencer of prescribing behaviour are the promotional campaigns organised by pharmaceutical companies. Pain medicine specialist Chris Hayes explains that those within the medical profession will not be surprised by this, but can be vigilant about having their professional judgement compromised. A couple of case studies provide context for the RACP’s Guidelines for ethical relationships between health professionals and industry.

Guests: Dr Christopher Hayes FFPMANZCA (Director Hunter Integrated Pain Service)
Clin Assoc Prof Adrian Reynolds FAChAM (Clinical Director Alcohol and Drug Service, Tasmania)

Written and produced by Mic Cavazzini. Music: Chris Zabriskie ‘Out of the Skies, Under the Earth’ and ‘What True Self Feels Bogus Lets Watch Jason X’;  Borrtex ‘You Are Not Alone’, Jahzzar ‘Missing You’   courtesy of Free Music Archive. Gunnar Johnsén, ‘Task At Hand 2’, ‘Task At Hand 5’ licenced from Epidemic Sound. Image courtesy of WikiCommons.