‘Reassuring’ findings for opioid clampdown policies\
06 Aug 2025
A new study, supported by general practice prescription data, found opioid-linked emergency presentations have dipped – but it’s created an unintended effect.
An Australia-first study looking at the impact of landmark opioid prescribing clampdowns found a ‘reassuring’ downward trend in emergency presentations – but also identified an immediate spike in ED visits for other drugs.
Historically, GPs have prescribed more than half of the country’s opioids, with a series of interventions over the past decade introduced to reduce opioid overprescribing.
Now, new research, published in the Medical Journal of Australia, has looked at hospital presentations among patients prescribed opioids, both before and after two of these interventions were rolled out in Victoria.
These included the significant changes to the Pharmaceutical Benefits Scheme (PBS) for opioids made in June 2020, which included reduced pack sizes and modified prescribing criteria, and the introduction of Victoria’s prescription drug monitoring program, which started in April 2020 and was the first mandatory statewide scheme introduced in Australia.
To assess their effect, researchers linked admission records from three hospital healthcare networks to primary health data, including from 562 Victorian general practices.
The research found emergency department (ED) presentations in the opioid group went down by 11.8 per 100,000 people relative to pre-intervention trends and compared to a control group.
However, researchers also identified a short-term but statistically significant rise of 7.3 ED presentations per 100,000 people linked to non‐opioid substances in the group that were prescribed opioids, again relative to pre-intervention trends and the control group.
Chair of RACGP Specific Interests Addiction Medicine Dr Hester Wilson noted that while the study was focused on Victoria, the results are likely to reflect wider trends.
‘Certainly, my experience and the experience of my colleagues about things like real-time prescription monitoring is that we were concerned that it would make conversations more difficult,’ she told newsGP.
‘But in actual fact, it’s enabled conversations.
‘The other dynamic that’s happening is that our patients see stuff in the media. They’ve seen the issues that have happened in the US … and so they’re more activated around the risk.’
The study authors said there are a variety of possible factors behind the immediate rise in non‐opioid substance‐related presentations and noted that the long-term pattern is not yet clear.
‘One possible mechanism underlying the increase in non‐opioid substance‐related harms could be related to increased prescribing of unmonitored pain medicines, such as pregabalin and tricyclic antidepressants, following the introduction of the prescription drug monitoring program,’ they wrote.
‘Other possible mechanisms underlying increased non‐opioid substance‐related harm could be substitution effects; that is, using non‐opioid medications instead of opioids.
‘We found evidence of these unintended effects only in the short term, with only limited evidence of longer-term negative effects.’
Their analysis also found increases in hospital and ED presentations for self-harm, but said these were not statistically significant. However, mental health-related ED presentations rose significantly among the opioid group.
The authors also wrote that the study is the first of its kind outside of the United States and is ‘of international relevance’.
They stressed that the findings underline the importance of measuring a comprehensive range of outcomes when evaluating opioid policies.
They also noted that while opioid use has decreased in Australia, the country still ranks eighth in the world per capita, and opioid consumption remains the leading cause of drug‐induced death.
An accompanying MJA editorial described the findings as ‘reassuring’, saying that ‘the policies have, at the very least, not increased the frequency of unintended harms’.
According to the Australian Institute of Health and Welfare (AIHW), opioids were present in more than half (51% or 830) of drug-induced deaths in 2023.
For Dr Wilson, the trends outlined in the MJA article are an indication that the impact of policy interventions are heading in the right direction.
‘Opioids are a life-saving, essential medicine that we want to be able to access for the times when it’s going to be a benefit – and that is for acute, severe pain and end-of-life care.
‘And we’re seeing a real shift which is really positive.’
Dr Wilson co-authored an article to support GPs’ clinical decision-making for long-term opioid use, which was published in last month’s Australian Journal of General Practice.