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[LILONGWE] African governments must urgently develop and implement evidence-based standards to curb the surge of inappropriate use of opioids, an expert says.

The call came after findings from a three-part overview series on pain management and opioid use following surgery suggesting increased use and misuse of prescription opioids globally over the past decade.

Opioids are a class of drugs that are usually used for managing moderate to severe pain, with some finding use in managing coughs and diarrhoea. People can become addictive to opioids, resulting in their misuse, experts say.

“Some drug companies have heavily marketed their products to encourage clinicians to prescribe more opioids.”

Paul S. Myles, Monash University

“Some drug companies have heavily marketed their products to encourage clinicians to prescribe more opioids,” says Paul S. Myles, a co-author of one of the studies and the lead of the series published in The Lancet this month (13 April). “In contrast, we know that better pain control can be achieved with a mix of painkillers, in part aiming to reduce the need for opioids.”

The series resulted from reviews of studies on opioid use after surgeries, with most data coming from high-income countries such as Australia, Canada and United States.

One of the studies says that pharmacy dispensing data from Brazil between 2009 and 2015 showed “greater than four-fold increase in opioid sales over this interval”, suggesting that the opioid problem is global.

“For countries in which access to opioids is limited but expanding, the experiences described show the importance of establishing and implementing evidence-based standards to encourage responsible opioid prescribing while also promoting effective pain management for patients after surgery,” the study adds.

Myles, director of the Department of Anaesthesia and Perioperative Medicine, Monash University, Australia, tells SciDev.Net that part of the problem is patient expectation, and calls for increased education on the negative effects of opioids.  

Myles says that many people including doctors and nurses think it is best to reduce all pain, and the most potent painkillers are opioids.

Opioids are near-essential for many types of surgery but are usually only needed for few days or weeks at most, he explains.

According to the series, clinical guidelines and policies must also provide consensus for prescribing opioids after surgery, offering clinicians default and maximum prescription levels. For example, there is currently no guide on how long surgical patients should remain on opioids.

Myles advises a need for better pain management after surgery through alternative medications without addictive potential. Reacting to the development, Dave Nkosi, a medical officer working at the Lilongwe District Health Office, Malawi, says, “Challenges of [opioid] addiction in Malawi are mostly managed through strict control of the prescribed drug access in hospitals.”

Nkosi adds that sometimes opioids may be available outside hospitals including markets, leading to misuse as people can get them without prescriptions.  
 
This piece was produced by SciDev.Net’s Sub-Saharan Africa English desk.

References

Mark D. Neuman and others Inappropriate opioid prescription after surgery (The Lancet, 13 April 2019)

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