New rules around opioid prescriptions leave few options for Australians in pain



During the two years Don Firth spent building his underground home, he took delivery of 14 truckloads of rock, made the mud bricks for the interior by hand and personally carried two semi-trailers worth of concrete blocks to the site.

The result was a stone house, built into the side of a hill in the Bega Valley.

And his efforts required a high dose of opioids every day.

The public-servant-turned-carpenter has compressed discs as well as osteoarthritis and after an accident years ago, one of his vertebrae is missing a spur.

Mr Firth now gets by with a low dose opioid pain medication for when he has “overdone it”, and last year discovered he would need a new doctor’s prescription for each packet of 20 pills.

“To get an ordinary appointment takes two to three months,” he said.

Don Firth compares a doctor’s prescription with a box of medication in front of a packed medicine cabinet.
Don Firth discovered the government had changed regulations regarding how opioids were prescribed when he went to his pharmacy for a new supply of painkillers.(ABC News: Brendan Esposito)

Mr Firth is one of millions of Australians who live with chronic pain who, last year, discovered accessing their medications would become far more difficult.

In June, the federal Department of Health changed the rules about how opioid medications were prescribed to tackle a rise in hospital admissions and deaths related to the drugs.

Chief executive of Pain Australia Carol Bennett said the changes had serious consequences for more than 3 million Australians who experienced chronic pain.

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Pain Australia CEO concerned about new rules around opioid prescriptions.

“Many people have been extremely distressed, some of them suicidal, and that’s been a really awful part of this policy change,” she said.

“We need to see better pain services in place and … that ideally would have happened before this policy change had been made.”

Australia in top 10 prescribing nations

Packets of prescription only opioid pain kills are shown among other medications taken by a person experiencing chronic pain.
A person experiencing chronic pain may be prescribed opioid-based medications, such as Targin.(ABC News: Mary Lloyd)

Under the new regulations, opioids are only recommended for acute pain, cancer pain and palliative care.

A Department of Health spokesperson said the changes were aimed at increasing patient safety and stopping the unnecessary loss of life due to overdose.

The spokesperson said key medical groups supported the changes.

In 2006, deaths involving opioids occurred in Australia at a rate of 22 people in every million, but by 2016, that figure had more than doubled to 53 people in every million.

It has since fallen, but health regulators are keen to avoid an opioid addiction crisis on the scale seen in the US, where in the past few years more than 140 people per 1 million died of an opioid-related overdose every year.

“We’re around eight to 10 in the world in terms of the volume of opioids we prescribe,” Suzanne Nielsen, deputy director at the Monash Addiction Research Centre, said.

Associate Professor Nielsen said Australia’s opioid mortality rate was about five or six years behind the US, but concern that Australia was on a similar trajectory to the US prompted local regulators to act.

Prevention key to pain management

Don Firth carries a train of seedlings through his greenhouse among benches containing trays of other plants.
Don Firth used to take high doses of opioids, but now prefers to limit the amount of work he does to manage the level of pain he experiences.(ABC News: Brendan Esposito)

One of the changes that came into effect in June 2020 is that opioids are now prescribed in smaller quantities and without repeat prescriptions.

Mr Firth remembers leaving hospital after knee surgery with a box of 100 tablets of Endone, a strong opioid.

“For a period there, I was not able to wake up before nine o’clock and I was losing a large part of the day,” he said.

It was only when he got in contact with the pain clinic at St Vincent’s Hospital in Sydney that he began to taper off the high-dose opioids.

Now he keeps a low dose of opioid medication on hand and makes sure he paces himself.

“Prevention is so much better than cure. When you are in physical pain, you’ve done too much,” he said.

Patients with ongoing pain are now encouraged to seek help from their GP, see a pain specialist and consider other therapies.

Janine Monty also uses opioids daily to manage pain caused by osteoarthritis and a degenerative bone condition.

When her GP told her last year that she would need to come off the medication altogether, she was shocked.

Janine Monty sits with her dog on a large rock surrounded by parklands.
Janine Monty said without some pain relief, she is too depressed to meditate.(ABC News: Mary Lloyd)

“Chronic pain is very complicated, and it’s much easier to just get rid of the problem by taking away the opioids, but that’s destroying lives,” Ms Monty said.

Hundreds of people contacted Pain Australia when the new regulations came into effect, with many saying they did not know what options were available or that they could not access alternative services like pain clinics.

“They’re not affordable, they’re not available,” Ms Bennett said.

Dr Nielsen agreed.

“We do need to make sure that when opioids are being stopped, that people have other tools in their toolkit to be able to manage their pain,” she said.

Opioid medications are not recommended as long-term options for most people with chronic pain, as the evidence is not strong that the drugs help relieve this type of pain, while they can have serious side effects.


In January, the Therapeutic Goods Authority (TGA) began a campaign to increase consumer understanding of opioid medicines and explain the risks of taking them long-term.

Ms Bennett welcomed the awareness campaign, but said the policy changes last year caught many people off guard.

“It’s a little bit overdue when it comes to people … arriving at their doctor’s surgery and discovering that they don’t have access to their usual pain relief,” she said.

A spokesperson for the Department of Health said the TGA contacted health professionals last May to explain the changes and offer guidance on talking to patients about pain management.

The spokesperson also said that before changing the regulations, the TGA consulted health and consumer organisations and considered 98 submissions that supported changing how opioids were prescribed.

‘I don’t get high off the medication’

Ms Monty has been encouraged to lower her daily dose of opioids before.

During previous attempts, her pain was so bad she stopped going to the gym, stopped walking her dogs, and shut her business down because she could not keep up with orders.

Janine Monty takes medication from a box while standing in her kitchen with all her medications on the counter in front of her.
Janine Monty said chronic pain was a complicated medical condition and some doctors were not keen to take on patients in ongoing pain.(ABC News: Mary Lloyd)

She said she has tried everything to manage her pain, including seeing a pain psychologist, learning to meditate, doing hydrotherapy, having cortisone injections and undergoing several surgeries.

Ms Monty now takes a slow-release opioid every day, as well as a fast-release version for breakthrough pain.

Without these, she said she is in too much pain to exercise and too depressed to meditate.

“The pain medications are the cornerstone of all the other treatments,” Ms Monty said.

“[They] reduce the pain enough so that I can do all these other therapies and live a healthier life.”

Ms Monty has now found a GP willing to prescribe the opioids she has been taking, when others would not.

Doctors are aware the government is keeping a close eye on opioid prescriptions.

In 2018, the Federal Government wrote to 4,800 doctors telling them they were among the top 20 per cent of opioid prescribers and could be over-prescribing.

“We don’t want to end up in the place that the United States is in where opioids are a national crisis,” Mr Hunt said at the time.

As a result, some doctors have stopped prescribing strong pain killers altogether.

“The issue isn’t that opioids should never be used for chronic pain, but the patient selection needs to be done very carefully,” Dr Nielsen said.

Ms Monty said she understood the new rules were introduced to tackle addiction but rejected the assertion she was misusing medication.

“I’m not addicted. I am dependent.”


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