General practitioners could be banned from prescribing strong painkillers in an attempt to prevent Australia following the United States into an opioid overdose epidemic.
Australia's drug regulator has warned the nation is "trending down a similar path" to countries enduring pharmaceutical drugs crises. More than half a million Australians are estimated to be dependent on their prescription painkiller.
In a consultation paper, the Therapeutic Goods Administration flagged the idea of preventing some doctors prescribing well-known schedule 8 opioids including morphine, oxycodone, fentanyl and pethidine.
This could mean the drugs no longer being offered by GPs, with people instead having to see specialists in palliative care, cancer or pain medicine.
It is one of a number of potential regulatory responses detailed by the drug authority and comes at a time when access to opioid painkillers is already being curtailed. Codeine products such as Nurofen Plus will no longer be available over the counter at pharmacies from Thursday.
Instead, access to these medications will require a doctor's prescription.
The move also follows growing concern about the unnecessary use of opioids, which many experts say is not effective for chronic pain or for use over long periods.
In 2016, there were about 11 deaths in Australia each week from prescription painkillers such as oxycodone, morphine and codeine. The death toll over five years was about 2700 people.
Accidental drug overdoses are now far more likely to be caused by pharmaceutical drugs than illegal drugs.
Matthew Frei, clinical director of drug and alcohol service Turning Point, said many Australians had come to believe they should not suffer from any pain at all, and a cultural change was needed from consumers, doctors and regulators.
"Unfortunately, I think this storm has aligned itself in North America and Australia at a time these drugs were marketed and promoted for non-cancer pain very strongly by the pharmaceutical industry," Dr Frei said. "I think we are in a very concerning situation."
But he cautioned against removing prescription powers for GPs, saying the nation's limited addiction services probably did not have the staff to handle the resulting wave of people seeking help for opioid dependence.
The idea was also criticised by Bastian Seidel, president of the Royal Australian College of General Practitioners, who said that while the review into schedule 8 painkillers was needed, he felt the Therapeutic Goods Administration had unfairly targeted GPs.
"We need to move away from blaming a particular group," he said.
Although the report suggested that the rules could allow remote GPs to keep their access to stronger opioids, Dr Seidel said city doctors also often performed care that needed schedule 8 opioids, including as palliative care doctors visiting people in the community.
Australia has the eighth-highest rate of opioid consumption in the world, ahead of Britain, New Zealand and France.
The United States leads the globe in its heavy use - more than double the rate of Australia, at about 50,000 daily doses per million inhabitants.
If you live in America and are aged under 50 years, you are now more likely to die from a drug overdose than anything else, with deaths now exceeding those at the height of the HIV epidemic.
Overdoses have claimed the lives of more than half a million Americans over 14 years - including about 20,000 deaths from powerful opioid fentanyl in 2016.
The agency is seeking submissions about ways to regulate access and curtail misuse of opioids in Australia. Other possible changes include reducing maximum pack sizes, new warning labels and mandatory education for doctors prescribing controlled substances.
The Therapeutic Goods Administration said "any regulatory response must not unduly restrict informed, rational prescribing of opioids".
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