3 million Aussies risking their lives
IF YOU had a serious toothache that was giving you grief, would you dose yourself with potentially deadly levels of heroin for months or even years to cope with the pain?
Even those with a serious fear of dentists would probably opt to go and get the tooth in question dealt with instead.
But for millions of Australians experiencing pain, turning to potent prescription opioids - essentially pharmaceutically produced heroin - is the norm.
Now, overdoses from legally obtained pills like oxycodone, endone and tramadol are killing just as many people each year as road accidents.
Leading surgeon Michael Wong said more people were dying now than during the highly publicised heroin crisis in the 1990s, yet we're not talking anywhere near as much about it.
"It's shameful," Dr Wong said.
"It's very serious and, unfortunately, very common. Far too many people are living on these very dangerous opioids and, as a result, becoming addicted to them.
"They're reliant on these medications and, more than that, they become tolerant to them and require more and more. And then they can't get off it."
In 2016, there were 1119 deaths from opioid overdoses in Australia - more than double the number just a decade earlier when 439 people died.
Data shows that three million Australians receive at least one prescription for opioid medications each year.
"I see patients on a daily basis and I'm baffled by how many medications they're taking and for how long they've been taking them," Dr Wong said. "It's shocking. It worries me."
The neurosurgeon and spinal specialist believes time-stretched general practitioners who operate in a medical system that doesn't allow them to spend a lot of time with patients are falling back on the "easy option".
"If you have a toothache, you wouldn't take opioid medications for the long term. You go to the dentist and get it fixed," Dr Wong said.
"But somehow, especially in my area of expertise, if you've got issues with back pain, people are quite comfortable to live on these pills. It's far better to investigate the source of the pain and fix it."
Instead, prescription pain medication is often the go-to solution for pain issues that can and should be addressed in other ways.
"In a chronic situation, doctors don't have the time and resources to look into the source of the pain and treat it - they're in the habit of prescribing medication to mask the pain," Dr Wong said.
"I don't want to blanket blame the primary care physician because it's the system - our system doesn't encourage or really allow GPs to spend more time with individual patients.
"To take time to do tests, to investigate issues, to explore treatment options, to see it through, to follow up … that takes a lot of time. Writing a script doesn't."
There are some instances where the source of someone's pain can't be eased by any means, including surgery, Dr Wong conceded.
"But that's very rare," he said.
"But even in those rare cases, I believe that there are alternatives to managing pain without resorting to long-term opioid use."
Two years ago, then president of the Royal Australian College of General Practitioners Bastian Siedel warned that the country was facing a "national emergency".
But the warning appears to have fallen on deaf ears.
Instead, many doctors have responded negatively to attempted interventions by authorities to kerb the skyrocketing number of opioid prescriptions.
Earlier this year, Brendan Murphy, the government's chief medical officer, wrote to 4800 GPs who were identified as being the top prescribers of opioids.
In the letter, Professor Murphy warned them to reassess their practices to ensure medications weren't being inappropriately given to patients.
He was later forced to ease tension the warning had created in some circles, apologising for "some anxiety and distress" caused.
"I want to reiterate that we strongly applaud and encourage the work of GPs who are working in palliative care, cancer management and in complex pain clinics," he wrote in an article for the RACGP.
"It would be most disappointing and undesirable if any such GPs feel their opioid prescribing practice is anything other than encouraged and supported."
Dr Wong said a more stringent prescribing culture was needed along with awareness of the effects of opioid consumption.
A greater focus is needed on non-pharmaceutical treatments for pain, from physical therapy to cognitive behavioural therapy, and non-addictive medicines to reduce inflammation.
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