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Box PHARMS1: Non-medical use of pharmaceuticals
Pharmaceutical non-medical use refers to the consumption of a prescription or over-the-counter drug for non-therapeutic purposes or other than directed by a registered healthcare professional (Larance et al. 2011). Pharmaceutical drugs may be consumed for non-medical use for a range of reasons including to induce euphoria, to enhance the effects of alcohol and other drugs, to self-medicate illness or injury, to mitigate the symptoms of withdrawal from alcohol and other drugs, or to improve performance.
In Australia, pharmaceutical drugs that may be used for non-medical purposes include opioids (painkillers/analgesics) and sedatives (sleeping/anti-anxiety medications). In recent years, there has also been rising concern about non-medical use of gabapentinoids (particularly pregabalin).
Pharmaceutical opioids are used to treat pain, some respiratory illness, and opioid (including heroin) dependence. 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.
Gabapentinoids are a group of drugs that were originally prescribed to manage epilepsy. They are increasingly prescribed for neuropathic pain (nerve pain). Examples include pregabalin and gabapentin.
The non-medical use of pharmaceutical drugs is an ongoing concern internationally, with different pharmaceutical opioids being misused in different regions.
The use of opioids (including the use of pharmaceutical opioids for non-medical purposes) in Australia in 2019 (3.3 per cent of the adult population) remains 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).
The Australian Criminal Intelligence Commission’s (ACIC) Illicit Drug Data Report (IDDR) includes data on prescription pharmaceutical detections at the Australian border (ACIC 2021). The importation of prescription pharmaceuticals is primarily undertaken by individuals for personal use and without criminal intent (ACIC 2021).
The number of pharmaceutical detections reported at the Australian border only reflect detections of benzodiazepines and opioids (including morphine, buprenorphine, methadone and oxycodone) (ACIC 2021). In 2019–20 there were a total of 1,112 pharmaceutical detections, a decrease of 8% since 2010–11 (1,211 detections) (ACIC 2021). The majority (73%) of these detections were for benzodiazepines (810 in 2019–20). However, though they remain the minority of overall pharmaceutical detections, there has been a 695% increase in the number of pharmaceutical opioid detections over the past decade (38 in 2010-11, increasing to a record high of 302 in 2019–20 (ACIC 2021).
Prescription drug dispensing
AIHW analysis of recent data from the Pharmaceutical Benefits Scheme (PBS) provides information on dispensing of prescription opioids, benzodiazepines and gabapentinoids in Australia (Box PHARMS2). These numbers largely represent medicines being prescribed for and used for their intended purposes. However, drug-related harms are often associated with drug prescribing rates (such as described for opioids in Roxburgh et al. (2017)) so it is important to monitor prescription rates in the context of harm reduction.
Recent data indicate that opioids continue to be dispensed at higher rates than benzodiazepines or gabapentinoids, but rates of dispensing have fallen or remained stable for all 3 drug classes over the past 5 years. Detailed information on specific drug classes and patient characteristics is outlined below.
Box PHARMS2: What is the Pharmaceutical Benefits Scheme?
The Pharmaceutical Benefits Scheme (PBS) was introduced by the Australian Government in 1948 to improve access to necessary medicines. Under the PBS, Australian residents can access a range of medicines at a cheaper price, subsidised by the Government. Most PBS-listed medicines can only be dispensed at a pharmacy (PBS 2022).
Data from the PBS provide information on the number of prescriptions (scripts) dispensed and the number of patients supplied at least one script within a given financial year. The PBS database includes information on a range of medicines that may be used for non-medical purposes or carry a risk of potential for harm (including opioids, benzodiazepines and gabapentinoids). Monitoring dispensing of these medicines under the PBS can provide information on the availability of these drugs among the general Australian population. The PBS also includes data on medicines that are used to help people stop or reduce their tobacco or alcohol consumption.
AIHW analysis of PBS data includes opioids, benzodiazepines, gabapentinoids, smoking cessation medicines and alcohol cessation medicines. See the Technical notes for a full list of item codes.
Dispensing of selected medicines by drug class and generic name
Data from the PBS indicate that in 2020–21:
- Around 14.0 million opioid scripts were dispensed to 3.0 million patients for pain relief, a rate of around 54,100 scripts and 11,600 patients per 100,000 population (not including prescriptions for the treatment of opioid dependence as these data are not available in the PBS) (Figure PHARMS1; tables PBS1-4).
- Oxycodone had the highest rate of scripts dispensed (19,500 scripts per 100,000 persons, compared with 14,100 for codeine). However, more patients were dispensed codeine than oxycodone (6,200 per 100,000 persons and 4,700 per 100,000 persons respectively). This may indicate that a higher number of PBS scripts for oxycodone were dispensed per patient than for codeine (Figure PHARMS1).
- Around 5.2 million benzodiazepine scripts were dispensed to 1.4 million patients, a rate of 20,000 scripts and 5,600 patients per 100,000 population. Diazepam had the highest rates of dispensing among benzodiazepine drugs (Figure PHARMS1; tables PBS21–24).
- Approximately 4.3 million gabapentinoid prescriptions were dispensed to 633,000 patients, a rate of around 16,600 scripts and 2,500 patients per 100,000 population. Pregabalin had the highest rates of dispensing among gabapentinoid drugs (Figure PHARMS1; tables PBS45–48).
Rates of dispensing across all drug classes were typically highest in Inner regional and Outer regional areas. See Data by region for information on PBS dispensing by remoteness area and state/territory.
Figure PHARMS1: PBS prescriptions dispensed or patients who were dispensed selected opioids, benzodiazepines or gabapentinoids, by drug class and generic name, 2012–13 to 2020–21 (number or rate per 100,000)