opioids for pain · lack of understanding twice as potent as morphine less ‘stigma’ compared...
TRANSCRIPT
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Lack of understanding Twice as potent as morphine
Less ‘stigma’ compared with morphine
Addiction Studies identifying oxycodone as being more
desirable Studies identifying oxycodone as being more
addictive (approx. 2 weeks)
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55 year old female Presented to ED Diagnosis (from iSoft) ▪ Sprain and strain of unspecified joint and ligament of
trunk (lumbar) ▪ Injured lower back at work 4 days prior to presentation
Discharged with paracetamol, ibuprofen ▪ 30 x OXYNORM 5mg
Pharmacy received phone call from GP expressing concern
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Obstetric case post c-section – a mother described receiving a medication that was so great all she wanted was more of the medicine and didn’t care about baby ▪ (on reflection it ‘was scary’)
Post orthopaedic surgery – patient went back to GP for
more because they were so good and was very angry when GP declined script. ▪ (patient reflected that they were really addictive)
Cardiothoracic surgery patient – kept on oxycodone (3+
years post surgery). GP unable to stop and now unlikely to ever be off opioids for the rest of his life (being changed to Methadone).
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Significant discussions with our Acute Pain Service Agreement to use morphine first line ▪ Oxycodone had become the first line agent ▪ Oxycodone removed from the MedChart ‘quickacol’
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Education, education, education Junior Doctor protected teaching Ward in-service Clinical Nurse Educators Grand Round
Discussion at local Medicine Review Group meetings and District Medicine Management Meeting
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Education comprised of Background of problem WHO anaglesic ladder ▪ Discussion of different steps
Philosophy of what we were trying to achieve Points to remember ▪ To highlight the lack of understanding and reinforce the
challenges we see. ▪ Comparison with morphine
Prescribing tips ▪ Quantity
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Southland Hospital Intern Pharmacist follow up project - audit ▪ To determine if the education had had an on-going
effect ▪ To determine if oxycodone is being used appropriately
for pain ▪ 2nd line which is consistent with hospital wide and Ministry of
Health campaigns
▪ To determine use on discharge ▪ Short term ▪ Long term
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0
500
1000
1500
2000
2500
3000
Uni
ts
Oxycodone Use
Capsules
Tablets
Linear (Capsules)
Linear (Tablets)
0
200
400
600
800
1000
1200
1400
Uni
ts
Morphine Usage (Units)
Cap
Tab
Linear (Cap)
Linear (Tab)
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Thank you!