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A national crackdown on the harmful overprescribing of medications will see thousands of healthcare workers push to wean Australians off unnecessary drugs, including sleeping tablets and opioids.
The world-first deprescribing program, launched by Monash University on Wednesday, comes as experts warn that chronic reliance on some medications is leading to severe and dangerous side effects and causing increasing patient harm.
Janney Wale began taking opioids daily to deal with the searing pain in her leg as she waited for knee replacement surgery.
“I was in this blur of, ‘I’ve got to have my pain controlled, so I can manage,’” the retired biomedical researcher said.
“I was taking huge amounts. I was feeling really unwell, not really coping with the pain anyway, but hanging out for the next three or four hours until I could take the next lot.”
At first, the 80-year-old Brunswick resident did not link her “extreme fatigue” or cognitive decline to her heavy intake of codeine.
But as the weeks went on, she found herself on the verge of tears every night. She noticed the throbbing pain in her knee was always there, no matter how many tablets she took.
Wale later discovered, following a medical appointment, that her blood electrolytes were severely “out of kilter” and she was suffering from critically low potassium levels.
“I didn’t realise what an effect taking that much codeine was having on me,” she said.
As part of the two-year program, about 7000 healthcare workers, including doctors, nurses and pharmacists from across Australia, will be trained to safely guide Australians to cut back on medications in cases where the harm outweighs the benefit.
Called SUPPORT-Meds, it will help Australians taper off sleeping pills, such as benzodiazepines and Z-drugs used to treat insomnia, as well as cut back on prolonged use of opioids for people with chronic pain unrelated to cancer.
While the push to reduce opioid use applies to all adults, the focus on cutting back sleeping pills will initially be aimed at Australians aged 65 and older.
Associate Professor Emily Reeve, at the Centre for Medicine Use and Safety at the Monash Institute of Pharmaceutical Sciences, is leading the program and said the goal was to protect people from the dangers that come from the unnecessary use of medicines.
Reeve said dependency often developed quickly with sleeping pills and prolonged use could lead to lingering cognitive impairment and elevate the risk of car crashes for all ages.
She added that while a patient might gain about 30 minutes of extra sleep when first prescribed the tablets, the body quickly adapts and builds a tolerance to it. With long-term use, the benefit decreases, but significant risks such as falls and fractures remain.
Reeve said long-term sleeping tablet use in older adults triggered a five-times increased danger of cognitive impairment, a four-times spike in daytime sedation, and doubled the risk of dangerous falls and fractures.
“If someone stops the medication abruptly because their body is used to it, it can trigger a severe withdrawal reaction,” Reeve said.
“This presents as insomnia and anxiety … the very symptoms the medication was meant to treat. Patients then think, ‘I must still need this pill’, not realising they are actually just suffering from withdrawal.”
She said the first-line treatment was a specialised form of cognitive behavioural therapy for insomnia.
The deprescribing program – which refers to a structured, supervised process of stopping medications that are no longer necessary or beneficial to the patient – will soon expand to phase out use of other medications, including antipsychotics and acid-reflux drugs.
The training for clinicians included evidence-based education on how to begin conversations about the hidden harms or side effects.
Wale is now opioid-free and a patient advocate who holds a PhD in pharmacology, but she said the insidiousness of how quickly she formed a dependence on the drugs still shocks her.
“There are many people who are prescribed a medicine and just keep taking it and keep thinking they need it, when it may often reach a point where they are probably better to look for alternatives,” she said.
Sydney GP and addiction specialist Dr Hester Wilson said programs such as this were crucial, but she added deprescribing can be “really tricky”.
“These medicines … they’re essential, and they’re great short-term, but the balance of benefit versus risk becomes increasingly dicey or fraught as people stay on longer,” she said.
“Sometimes for the person it can feel like the withdrawal experience is just too much to cope with, and people can feel like the things that have helped them to keep their life going are just being taken away.”
Wilson said a person’s dependence on the medication was often not clear until the dose was reduced.
“This is time-consuming and doing this, it’s not a once-off,” she said.
“It’s a conversation that sometimes can go for some time. You’ve got to be able to sit with them and allow them to express their fears and anxieties and support them through it. It’s more than just education. There’s got to be ongoing support.”
Almost 40 per cent of Australians aged 75 and older take five or more prescription medicines. This figure skyrocketed to between 80 and 90 per cent for people living in aged care facilities, where many take 10 to 15 different drugs.
Melissa Cunningham is a health reporter for The Age. She has previously covered crime and justice.Connect via X or email.From our partners
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