12th Nov 2018
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Opioid abuse and antibiotic misuse identified as critical threats

Abuse and inappropriate prescription of opioids and antibiotics have been recognised as a threat to the public. Opioid overdoses are now killing three Australians a day on average. Around one-third of antibiotic prescriptions have been assessed as non-compliant with treatment guidelines and one in four have been deemed inappropriate. 

The Antimicrobial prescribing practice in Australian hospitals: Results of the 2017 Hospital National Antimicrobial Prescribing Survey released today by the Australian Commission on Safety and Quality in Health Care, is a report aimed at improving the use of antibiotics in Australian hospitals.

The 2017 report summarises the results of a voluntary audit of 314 hospitals across Australia, and analysis of 26,277 prescriptions for 17,366 patients.

To help promote responsible use of antibiotics, the commission analyses prescribing patterns and infection data, working with the medical sector to improve clinical care.

While the report revealed that there have been some improvements in hospital practices over the past five years, it also found that other strategies are fuelling resistance to antibiotics and other antimicrobials, which now poses a critical threat to public health.

Compliance with antibiotic guidelines declined from 72.2 per cent in 2013 to 67.3 per cent in 2017. Almost one quarter (23.5 per cent) of prescriptions were assessed as inappropriate, and almost one third (32.7 per cent) were non-compliant with guidelines.

Inappropriate use and abuse of antibiotics encourages resistance to these medicines, and contributes to the spread of superbugs.

“Overuse and inappropriate use of antimicrobials is a key factor contributing to bacteria and other pathogens becoming unresponsive to last-line drugs,” said Dr Kathryn Daveson, clinical director of the AURA Program at the Commission.

“These results are hugely concerning as ongoing inappropriate use of antibiotics assists bacteria to evolve increased resistance to existing antibiotics. This misuse places a heavy burden across the population, with a disproportionate impact on vulnerable communities, such as aged-care residents and people in rural and remote areas.

“Clinicians are already seeing the impact of antimicrobial resistance, with increasing challenges in treating people for common illnesses. Ultimately, we may lose the effectiveness of antibiotics to keep us healthy when we most need them,” she said.

The commission hopes to promote the responsible use of antimicrobial drugs, including antibiotics and antifungals, to address increasing rates of drug-resistant infections.

“We need to improve prescribing to keep patients safe and reduce the impact of antimicrobial resistance,” said Associate Professor Kirsty Buising, deputy director of National Centre for Antimicrobial Stewardship (NCAS).

Opioids are also harming or killing Australians, with an Australian Institute of Health and Welfare (AIHW) report showing that three people a day die from their misuse.

A national strategy to combat addiction included bans on purchases of over-the-counter codeine, but it seems that where there’s a will there’s a way, with one in 10 people believed to be using illegal opioids or misusing prescription drugs.

So far, the number of opioid-related deaths in 2016, the most recent year for which data was available, hit 1119 – the highest death toll since a peak of 1245 in 1999.

“Every day in Australia, there are nearly 150 hospitalisations and 14 presentations to emergency departments involving opioid harm, and three people die from drug-induced deaths involving opioid use,” said AIHW spokeswoman Lynelle Moon.

“The number of deaths involving opioids has nearly doubled in the decade to 2016, from 591 to 1119. Put another way, this is a rise from about three deaths involving opioids in every 100,000 people to about five.”

Opioid-related deaths are now more likely than fatalities caused by illicit substances, and the same applies to hospitalisations, which increased 25 per cent over the decade.

Last year, 15.4 million opioid prescriptions were dispensed to 3.1 million people under the Pharmaceutical Benefits Scheme. Oxycodone, otherwise known as ‘Hillbilly Heroin’, which many older Australians use to treat moderate and severe pain, was the most commonly dispensed prescription opioid.

How careful are you with your prescriptions? Are you shocked by the number of deaths caused by opioid misuse? Do you take antibiotics whenever they are prescribed to you? Or do you question your prescription?

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    COMMENTS

    To make a comment, please register or login
    Julian
    12th Nov 2018
    11:56am
    As usual, it's those who misuse drugs who ruin it or make it difficult for those in genuine need.
    ray from Bondi
    12th Nov 2018
    6:27pm
    Yes I agree, My wife was on steroid that was misused by sports people, she really needed it and it helped her immensely now it is forbidden and because of her condition has not been offered anything to help, this was cheap simple and it the job, but our benevolent government has banned it because a few sorts people abused it, disgraceful and shows a complete lack of empathy by both governments.
    I know this is an opioid discussion but I believe it is related.
    Old Geezer
    12th Nov 2018
    12:02pm
    No I am not shocked by the number of deaths as most occur because people have had enough and want to leave our planet rather than suffer.
    Mez
    15th Nov 2018
    10:47am
    That is probably correct and is very sad indeed.
    Maybe we need to look at the reasons for the pain, how the condition originated and tackle the origins and causes.
    In many cases, hospital admissions are cancers and coronaries and suicide attempts.
    Cancers and cardiac conditions usually caused by stress and obesities and these are closely linked with over eating and excessive alcohol consumption and these are linked to over consumption of sugars and people's addiction to it.
    Alcohol transforms into blood sugars as well so the present push on taxing sugary foods is very good but still more needs to be done with advertising as well as supermarkets and petrol stations removing displays of sweets and processed foods well away from points of sales to minimise customers from succumbing to temptations whilst queuing to be served, especially when kids are in tag as well.
    musicveg
    18th Nov 2018
    1:26pm
    Mez, it is also the fat, too much protein, not enough veg and fruit. Sadly the "medications" that people take also contribute, it wears the liver out and causes heart failure.
    KSS
    12th Nov 2018
    12:51pm
    It's not just antibiotic prescribing in hospitals that is the issue, it is also patients demanding them and GPs giving them to avoid lawsuits even when an infection is caused by a virus not a bacteria. Who is going to deny a mother demanding antibiotics for her child's earache even though the earache will get better by itself with no treatment? Then there's patient responsibility for not taking them as prescribed e.g. stopping when symptoms abate and 'saving' the medication for future use. All this does is teach the still lingering bacteria how to become resistant in future. Then there's all the products with antibacterial properties that are sold in every supermarket, such as soaps, cleaning cloths, cleaning products, wipes etc. These are all totally unnecessary for everyday use.

    As far as opiate abuse is concerned, this is a minority of users and making these medications prescription only will not prevent abusers abusing them. Unless you are going to operate in the same way as say opiate substitution centres do, i.e. the patient turns up for their methadone that they must take there and then, it is impossible to prevent people from overdosing on other opiate medication when left to their own devices.
    musicveg
    18th Nov 2018
    1:28pm
    Yes, the chemicals in cleaning products are a big problem, they get into your organs and cause mayhem.
    Charlie
    12th Nov 2018
    10:21pm
    This only establishes the association between death and the taking of opioids. It doesn't say...

    Was the person prescribed the opioids or did they get them from somewhere else?

    Was the death from opioids intentional or accidental?

    Now that its become acceptable to purposely end your life in hospital with a lethal dose of drugs, suicide doesn't seem so wrong, so a person may wan't to do it themselves.

    People with opioid chronic pain medication over a period of years, are what the hospital calls "self medicating", meaning a fair amount of the drug like one month supply, can be kept at home. It has to be this way because the patient cant be going for a script every week. Sure there is enough in one month supply to end a life.

    Getting desensitized to the drug, is said to cause the user to want more and more, to get the same pain protection.
    Some doctors say that this predicament can be relieved by changing from one opioid type to another.
    I have not yet seen an acceptable change over plan, as they seem to be designed for a person lying in a hospital bed, but not for somebody wanting small enough change over doses, to continue walking around and living independently. This is especially relevant for public hospital pharmacies as they don't keep every size of tablet.
    Mez
    15th Nov 2018
    10:33am
    Precisely my thoughts when reading the article.

    Maybe this problem will be decreased once the My Health Record takes on full effect as pharmacies will be able to see your full or part health records which includes pharmaceutical purchases and medical prescriptions.
    johninmelb
    18th Nov 2018
    11:53am
    The PBS system can be tweaked so that people that need ongoing medication of this type can get it but not in bulk quantities.

    The supply can be restricted by only dispensing say 7 tablets at a time. The doctor writes the script with repeats as he probably does now, but instead of getting 30 days supply, the patient can only get say 7 days, and can only return to the pharmacist a day before the last tablet. Yes, it is inconvenient, but the patient doesn't need to front up to the doctor every week for a new script. It won't solve the problem of people deciding to end it, as 7 tablets might well be enough, I don't know about those sorts of things.

    Secondly, not sure about the scope of MHR, but we already have Medicare cards, and that system could easily be used to restrict strong drugs and doctor shopping etc. The debacle over codeine based pain killers could have easily been dealt with by making people present their Medicare card with photo id, and recording purchases of Codral or Panadeine etc, on a national database, and only allowing sales of small quantities after discussion with the Pharmacist.
    musicveg
    18th Nov 2018
    1:31pm
    My brother died from taking too many opiods, mixed with a few other things, the heart just stops. He was found with a big bag of pills in his flat, all legally supplied by his doctor. Why so many? I agree with Johninmelb, restrictions need to be applied.
    Mez
    15th Nov 2018
    10:27am
    Tuberculosis medication is often mis used and is of great concern to us in the medical and hospital areas because people do not complete the full dose correctly, hence the bacteria has become resistant.
    The medication is a longterm one and the problem is that they become very complacent and careless in adhering strictly to the instructions.
    musicveg
    18th Nov 2018
    1:34pm
    All these pills do is mask the problem, nothing solved, makes it hard for your liver to work, and ends up causing you heart failure. Pharmaceutical companies love it, making money on people's vulnerability. Why they are trying to stop the legalization of medical marijuana, because it works with no side effects and no one has even died from it.
    Yup I Know
    19th Nov 2018
    6:02pm
    With you Old Geezer. Maybe the grandma who writes these articles is with you also,


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