The drug that killed popstar Prince is being prescribed to New Zealand's elderly in record numbers, prompting a warning from the Government health watchdog.
The spike in prescriptions of fentanyl - a synthetic opioid 50 times more potent than heroin - is being described as "opioid rain" by alarmed medical professionals.
An investigation has found rates of prescribing have doubled in rest homes in four years, while doctors are dishing out strong opioids to already frail over-80s around 10 times more often than to those under 65. Prescription rates varied wildly between regions. This is despite research showing the effects of strong opioids are worse in the older population, and are more likely to cause falls, mental health problems, constipation, nausea, and overdose.
Musician Prince died from an overdose of fentanyl at his home in Minnesota in April, aged 57. Mis-labelled pills found at his house reportedly contained the substance. Fentanyl is recommended for people with chronic cancer pain.
Geriatrician Dr Alan Davis led the Health Quality and Safety Commission investigation into the prescription of opioid drugs. He said he was concerned that fentanyl was replacing oxycodone, or "hillbilly heroin" as the overprescribed opiate of choice. "It's fair to say that fentanyl has to an extent filled in the vacuum left by oxycodone. It's something that we don't want to see."
Prescriptions of oxycodone rose 249 per cent between 2007 and 2011, but were now falling rapidly. Meanwhile, prescriptions of fentanyl rose 150 per cent in the highest-use areas of Whanganui and Bay of Plenty, and 80 per cent in the Capital and Coast District Health Board area.
"It's a potent opioid, and it has the potential for adverse effects - respiratory conditions, it's potentially very addictive," Davis said. It should be used to relieve terminal cancer pain, but there were fears it was being prescribed for general pain relief. "I would be concerned that people are getting these drugs when they don't have cancer ... if it's used appropriately it's no more dangerous than any of the other opioids, but we don't want to see it used in ways where it might not be helping."
The Commission's Atlas of Healthcare Variation also found strong opioid presciption had risen 20 per cent in four years. Figures did not include in-hospital dispensing of opioids, where they were mainly used for acute pain relief. This would be considered in a separate report. Opioid use in this country is still lower than in Canada and the US. Last year, 16.4 people per 1000 were prescribed a strong opioid in New Zealand.
The University of Otago's Pharmacovigilance centre had been approached for details on any fentanyl-related deaths in this country.
25 August 2016
Photo: JEAN-PAUL PELISSIER
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