This is in direct contrast to the “heroin epidemic” of the 1990s, during which time the majority of opioid deaths were linked to illicit substances. While the numbers are not as damning as those seen in the US, which is currently in the grips of an opioid crisis, there are fears that Australia is heading down a similar path. Better knowledge and access to information about these drugs is essential to improving patient safety outcomes, as is the introduction of a real-time prescription monitoring system.

Opioids are a class of medications generally used for pain relief, which bind to opioid receptors within the nervous system and block pain signals from being sent to the brain. In a nutshell, they alter a person’s sensation of pain, which is why they are well recognised as being among the most effective painkillers in existence.

The best known opioids include the likes of codeine, morphine, tramadol, methadone, fentanyl and heroin (the latter being the only illegal substance among these). While, traditionally, they have been prescribed for end-stage cancer patients and given as post-operative pain relief or in conjunction with anaesthetic, prescription opioids are increasingly used in the treatment of chronic pain and acute, breakthrough pain symptoms in a variety of patients. Up until recently, codeine has also been present in some over-the-counter medications (Panadeine and Nurofen Plus); however, in February 2018 these products became prescription-only.

Opioids are very powerful substances and, while they are considerably more potent than most other types of pain relief, potency can vary quite significantly between opioids themselves. Take, for instance, fentanyl, a drug that garnered considerable attention after being implicated in the death of singer-songwriter Prince. It is 50 to 100 times more potent than morphine and, to put it into greater context, 30 to 50 times more potent than heroin.

As they work directly on the part of the brain that controls and regulates breathing, opioids in higher doses can slow and impair a person’s breathing rate and, in some circumstances, cause loss of consciousness. These risks are increased when opioids are combined with depressant or sedative substances (including alcohol), which are often found in fatal drug overdoses. Opioids can also cause severe complications for people with certain medical conditions.

Even if they are not necessarily addicted to the medications, patients can develop a physical dependence on opioids – particularly with long-term use at higher doses. This can cause withdrawal symptoms, especially in people who stop taking opioids very suddenly, and can leave them susceptible to overdose. For this reason, it is imperative that medications are discontinued in accordance with medical advice.

The federal government has sought to develop and fund an electronic reporting system that will allow health care providers to monitor the supply of prescription medications to patients in real-time. However, the Department of Health has indicated that the implementation of this system in Queensland could be five years away. As highlighted by Coroner James McDougall during a recent inquest into four separate opioid-related deaths, an alarming number of further deaths are likely to occur during this five-year period, which is why it is imperative for the Department and other state and territory governments to treat the issue more urgently.

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To help alleviate the risk of accidental overdose and other potentially-fatal effects in the meantime, patients should hold discussions with their GPs and other prescribing medical professionals before taking opioids or new types of opioids for the first time. There are some simple questions you can ask your doctor which can go a long way to improving your safety when using these powerful drugs. Consider asking if opioids are necessary to treat your condition, or if there any other medications or non-drug therapies that would be effective; ask how much and how often you should be taking the medication; what sort of side-effects would require urgent medical attention; and what you should do if you miss a dose or think that you might have taken too much.

You should also make certain that your health care professional is aware of your complete medical history and any other medications which you might be taking to ensure that opioids are safe for you. If you are considering stopping an opioid or you are advised to do so by a medical professional, ensure that you get clear instructions about how to wean off your particular medication. It is also advisable to seek regular, ongoing review with your prescribing doctor to see how you are progressing and to discuss any potential changes in dosage or medication.

Louis Baigent is a medical negligence lawyer at Maurice Blackburn.