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The situation in New Zealand
Between 2008 and 2013, the number of dispensed prescriptions for strong opioids in New Zealand has increased significantly (Figure 1). Much of this increase is attributed to a growing number of dispensed prescriptions for oxycodone. The most recent dispensing data from 2013 suggests that the number of prescriptions for oxycodone may be reaching a plateau, but the fact remains that oxycodone is a second-line option for moderate to severe pain, and should be dispensed considerably less than morphine.
The type of prescribers initiating oxycodone remained similar in 2013, compared with when first reported in 2011. Approximately 30% of prescriptions for oxycodone are written by General Practitioners and the remaining 70% are from other clinicians, e.g. those working in secondary care.5 In 2013, the proportion of prescriptions initiated in secondary care and continued in general practice was 17%, the same figure as in 2011 (Figure 2).5
Given the current best practice recommendations that oxycodone generally be reserved for second-line treatment after morphine, it is concerning that approximately 80% of patients prescribed oxycodone for the first time in 2013 did not have a previous prescription for morphine in the preceding 12 months.5 This suggests that the majority of first-time prescribing of oxycodone is occurring before a trial of morphine, or alternatively, patients are being treated in hospital with parenteral morphine or pethidine and discharged with oral oxycodone.
For further information see: "Oxycodone use still increasing", BPJ 36 (Jun, 2011). "Update on Oxycodone what can primary care do about the problem", BPJ 44 (May 2012).