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Box PHARMS1: Common pharmaceuticals used for non-medical purposes in Australia
In Australia, pharmaceutical drugs that are most often subject to non-medical use are opioids (painkillers/analgesics) and sedatives (sleeping/anti-anxiety medications).
Pharmaceutical opioids are used to treat pain and opioid (including heroin) dependence and examples include oxycodone, buprenorphine and codeine.
Sedatives are a group of drugs that cause calming and sedative effects due to their depressive activity on the central nervous system. Benzodiazepines comprise the largest group of drugs in this class and examples include diazepam, alprazolam and temazepam.
The non-medical use of pharmaceutical drugs is an ongoing concern internationally, with different pharmaceutical opioids being misused in different regions.
In Australia in 2019, past-year use of opioids (including the use of opiates and the use of pharmaceutical opioids for non-medical purposes), was 3.3% of the population aged 14 and over. This is higher than the global average (1.2% of the global population aged 15–64 years). In 2019, the majority of pharmaceutical misuse in Australia continued to be for codeine (UNODC 2021).
Dramatic increases in opioid-related deaths associated with rising use in the US have led to the problem being declared an 'epidemic' (CDC 2017; U.S. Department of Health & Human Services 2017). In the US in 2019, 3.6% of the population aged 12 and older had misused pharmaceutical opioids at least once in the past year (UNODC 2021).
Opioids
In 2019–20, data from the Pharmaceutical Benefits Scheme (PBS) indicate that approximately 15.2 million opioid prescriptions were dispensed to 3.1 million patients for pain relief (that is, excluding prescriptions for the treatment of opioid dependence) (Figure PHARMS1; Tables S2.7a and S2.8a). Oxycodone was the most commonly dispensed opioid (5.2 million prescriptions dispensed), but more patients were dispensed codeine (1.7 million patients) than oxycodone (1.2 million). This suggests that there was a higher number of PBS prescriptions dispensed per patient for oxycodone than codeine.
Between 2012–13 and 2015–16, there was an increase in the age-standardised rate of opioid prescriptions dispensed (from 53,801 per 100,000 to 58,485) and the rate of patients who received a PBS supply of an opioid (from 12,126 per 100,000 to 12,686). This trend then reversed, decreasing to 53,427 scripts dispensed per 100,000 and 11,480 patients per 100,000 in 2019–20.
- Oxycodone and codeine had the highest rates of prescriptions dispensed and patients per 100,000 across the period.
- The rate of prescriptions dispensed was lower in 2019–20 than 2012–13 for all opioids, with some exceptions:
- The rate of oxycodone prescriptions dispensed declined from 21,325 per 100,000 population in 2016–17 to 18,132 in 2019–20, but remained higher than in 2012–13 (16,364 per 100,000).
- The rate of tapentadol prescriptions dispensed has steadily risen from 8 per 100,000 population in 2013–14 to 3,730 per 100,000 in 2019–20.
- The rate of patients who were dispensed tapentadol also increased, from 6 per 100,000 in 2013–14 to 839 in 2019–20 (Figure PHARMS1; Tables S2.7b and S2.8b).
Dispensing of prescription opioids may have been affected by recent policy changes. Please refer to the Policy context section for more information.
Benzodiazepines
PBS data indicate that dispensing of prescription benzodiazepines is also common. In 2019–20, approximately 5.5 million benzodiazepine prescriptions were dispensed to 1.5 million patients (Figure PHARMS1; Tables S2.7a and S2.8a). Diazepam was the most common benzodiazepine dispensed in 2019–20 (2.5 million prescriptions dispensed), and there were also more patients who received a PBS supply of diazepam than for other benzodiazepines (787,000 patients).
Between 2012–13 and 2019–20, there was a steady decrease in the age-standardised rate of benzodiazepine prescriptions dispensed (from 26,496 per 100,000 in 2012–13 to 19,533 in 2019–20) and the rate of patients who were dispensed a benzodiazepine (from 6,480 per 100,000 in 2012–13 to 5,573 in 2019–20). However, dispensing varied across benzodiazepine drugs over time.
- Diazepam and temazepam had the highest rates of prescriptions dispensed and patients per 100,000 across the period.
- The rate of benzodiazepine prescriptions dispensed decreased from 2012–13 to 2019–20 across all benzodiazepine drugs.
- However, for diazepam, the rate of patients increased from 2,767 per 100,000 population in 2012–13 to 3,013 per 100,000 in 2019–20 (Figure PHARMS1; Tables S2.7b and S2.8b).
Dispensing of prescription benzodiazepines may have been affected by recent policy changes. Please refer to the Policy context section for more information.