A new study has revealed that only 11% of Japanese aged care facility residents are prescribed regular pain medications compared to 74% of Australia’s aged care facility population.

Furthermore, the use of opioid pain medicines in aged care facilities was found to be 30 times higher in Australia.

Opioid use is common among adults aged 65 and older as medicines like morphine and oxycodone are frequently prescribed for chronic pain related to arthritis, urinary tract infections (UTIs), circulatory problems and other health issues. However long-term use of opioids remains controversial and poses risks of drug dependence and severe side effects.

Side effects of opioid use experienced by older people can include:

  • Nausea and constipation
  • Urine retention
  • Central nervous system effects (sedation, mild cognitive impairment, respiratory depression)
  • Increased sensitivity to pain
  • Cardiovascular and endocrine system effects

The new study led by Monash University’s Centre for Medicine Use and Safety (CMUS) in collaboration with Japan’s Institute for Health Economics and Policy, compared pain medicine use among two samples of Australian and Japanese residents to better understand the pharmacological management of pain in residential aged care.

Qualitative data obtained through focus groups with Australian and Japanese healthcare professionals highlighted the differences in therapeutic goals, painkiller regulations and treatment durations between the two countries.

Research from 2022 to systematically review the prevalence of opioid prescribing, dispensing and administration in Australian aged care facilities found that up to half of the participating residents were dispensed opioids over 12 months.

Other research observed higher prescription rates of opioids in residential aged care during the first year of the COVID-19 pandemic compared to the year before, with it being particularly more prevalent in rural and regional areas.

Suggestions were made for a more rigorous measurement structure to be put in place to ensure opioid appropriateness.

The CMUS study’s lead author and pharmacist, Laura Dowd, said these differences may explain the disparities in painkiller use between the respective countries.

“Australian participants described their therapeutic goal was to alleviate pain and reported painkillers were often prescribed on a regular basis, whilst Japanese participants described their therapeutic goal was to minimise impacts of pain on daily activities and reported opioid painkillers were prescribed for short-term durations, corresponding to episodes of pain,” Ms Dowd said.

“Australia and Japan both have rapidly ageing populations but appear to have very different patterns of painkiller use. Understanding these differences can inform new initiatives to improve pain management.”



Senior author and CMUS Research Fellow Dr Amanda Cross said, “This study confirms previous CMUS research that shows up to one-third of Australian residents are prescribed opioid painkiller medicines and highlights key areas where on-site aged care pharmacists could work to support the appropriate use of opioids.”

Dr Shota Hamada from the Institute for Health Economics and Policy in Tokyo said, “Painkillers are one component of an effective pain management strategy. Understanding the different role of painkillers as part of the overall approach to pain management will help the safe and effective painkiller use.”

In June 2020, the Federal Government made several changes to regulations that govern the prescription and supply of opioids, however, changes to medication regulations alone are a one-dimensional strategy to reduce opioid use.

Just last year The Royal Australian College of General Practitioners (RACGP) Chair of Specific Interest Addiction Medicine, Doctor Hester Wilson, said the medical field needs to move away from considering opioids as a long-term treatment for older people with chronic pain as they are often on multiple medications that could react badly.

“As we age, our body’s ability to manage medications changes so we’re more likely to get side effects,” she said.

“Not everybody is the same, but many of my older patients are very trusting and if I give them a medication they just take it. So for older people living in the community, it’s really important to take a look at your medicines, have conversations with your GP and pharmacists, and look at what risks are associated with your medicines.”

SOURCE: Hello Care