On Wednesday morning we were delighted to host over 40 clients from the health sector and an expert panel to explore what measures we can employ to tackle the misuse of opioids in Australia. This followed two previous seminars in Brisbane and Melbourne addressing the issue with each session reflecting the different State regulatory environments.

In the US in 2016 more people died from opioids misuse than breast cancer (41,070), auto accidents (37, 461) or guns (38,000). (Forbes)
While in Australia we are not facing a crisis on the same scale, it is still sobering to see that between 2011 and 2015 we have experienced a 60% increase in opioid related deaths.

Dr Jennifer Stevens, Anaesthetist at St Vincent's Hospital outlined her innovative and incredibly impressive work to reduce the rate of inappropriate opioid prescribing. Dr Stevens used data to show junior doctors in supportive face-to-face meetings their rate of opioid prescription against recommended guidelines. The program established by Dr Stevens and her colleagues uses the PharmaLytics tool (developed in conjunction with eHealth NSW and freely available to public hospitals) to analyse and report the data. It has resulted in a stunning 62% reduction in the level of inappropriate opioid prescriptions dispensed by the hospital.

Dr Stevens is now turning her attention to the particular challenges which arise in regional and rural areas where the rate of opioids misuse and related harms continues to rise.

Mr Bruce Battye, Director, Pharmaceutical Regulatory Unit and Deputy Chief Pharmacist, NSW Ministry of Health provided us with an outline of his Unit's work and the challenges associated with identifying and addressing problem prescribers.

Our panellists agreed that the complexity of the problem requires a multifaceted approach including better education and training for clinicians and pharmacists, collaboration between regulators and monitoring systems such as real time prescription monitoring (not in itself a panacea, but a useful tool). There was recognition of the powerful role of the consumer and the need for a rigorous public health campaign on the effect of opioid use.

A lively Q&A session raised many interesting legal challenges:

• privacy concerns in relation to new forms of prescription monitoring and clear legal frameworks in relation to collection of and access to patients' information; 
• the management of employees with access to opioids who self-administer;
• the management of AHPRA/disciplinary action;
• the first civil claims against doctors who fail to warn about the risks of addiction; and
• the management of coronial inquests.

We look forward to the continuation of this important conversation across the health sector.