Opioid medicines dispensing, all ages, from 2016–17 to 2020–21

Opioid medicines are indicated to manage acute pain, cancer pain and pain in a palliative care setting.¹ Specific opioid medicines (methadone or buprenorphine) are also used to manage opioid dependence (opioid-substitution therapy).

Inappropriate prescribing and misuse of opioid medicines can lead to dependence, accidental overdose, and poor treatment outcomes, including inadequate pain control² and risk of infection,³ hospitalisation or death.⁴

Using opioid medicines can also distract from non-pharmacological pain management strategies, such as exercise, psychology, nutrition and social connection, which are more likely to reduce pain intensity over time in people with chronic non-cancer pain.⁵ Evidence from specialist multidisciplinary pain clinics in Australia and New Zealand shows that opioid cessation, rather than maintenance, is associated with the greatest improvement in pain intensity, function and related psychological measures in people with chronic non-cancer pain.⁶

Although opioid medicines are used for chronic non-cancer pain, they are not recommended for this purpose except in exceptional circumstances because there is evidence that they have little benefit and increase the risk of significant harm.^1,5

The long-term use of opioid medicines for non-cancer pain can lead to physical and psychological harms and dependence.² Legal or prescribed opioids are more likely than illegal opioids such as heroin to be involved in hospitalisations or death.⁴ There was a 25% increase in unnecessary hospitalisations due to poisoning associated with prescribed opioids in Australia between 2007­–08 and 2016­–17.⁴ In 2019, prescribed opioids accounted for 429 – or almost half (49%) – of unintentional drug-induced deaths involving opioids.⁷

In recognition of the harms associated with opioid medicines use, in 2020 the Therapeutic Goods Administration (TGA) restricted the registered indications for use of opioid medicines to manage chronic non-cancer pain except in exceptional circumstances and asked sponsors to register additional smaller pack sizes for immediate-release products.¹

Although GPs are the largest group of prescribers of opioid medicines,⁸ opioids use in Australia often starts in the acute care setting.⁹ A survey of hospital pharmacists in Australia found that opioid medicines are frequently supplied for patients to take home after surgery “just in case”.¹⁰

The Third Australian Atlas of Healthcare Variation found a 5% increase in the rate of opioid medicines dispensing between 2013–14 and 2016–17. Almost 15.5 million prescriptions were dispensed through the Pharmaceutical Benefits Scheme (PBS) in 2016–17 compared to nearly 14 million prescriptions in 2013–14.¹¹ In 2020, the overall volume of opioid medicines (defined daily dose) dispensed in Australian adults was 1.6 times the average of the OECD (Organisation for Economic Co-operation and Development) countries. Although this was slightly lower than in 2019, Australia had the third highest defined daily dose per day of OECD countries for both years.¹²

Given the high use of opioid medicines, and continuing concerns about harms, it is time to re-examine trends in opioid use.

This report examines PBS prescriptions dispensing for opioid medicines for all ages across five years, from 2016–17 to 2020–21.

Data are reported according to where people live. The report presents national data, and data by state and territory, Primary Health Network (PHN) and local area (Statistical Area Level 3; SA3).

The report presents interactive data visualisations for:

• National, state and territory trends
• PHN trends
• Patient rate and defined daily dose rate 
• Remoteness and socioeconomic status.

The report, which builds on previous findings from the Australian Atlas of Healthcare Variation Series, covers dispensing rates for all opioid medicines that are PBS-listed for analgesia (including medicines listed on the palliative care schedule). These are medicines that contain buprenorphine, codeine, aspirin and codeine, fentanyl, hydromorphone, methadone, morphine, oxycodone, oxycodone-naloxone, paracetamol and codeine, tramadol and tapentadol. Opioid medicines that are PBS-listed for the treatment of opioid addiction are not included.

Data are sourced from the PBS dataset. This dataset includes all prescriptions dispensed under the PBS or the Repatriation Pharmaceutical Benefits Scheme (RPBS), including prescriptions that do not receive an Australian Government subsidy. The dispensing of a medicine does not always mean the medicine is consumed. Some medicines may not be taken after dispensing or people may stop taking them.

Data used in this report exclude doctors’ bag items and any programs with alternative supply arrangements where patient level details are not available, such as direct supply to remote Aboriginal health services.

The PBS and RPBS do not cover medicines supplied to public hospital inpatients, over-the-counter medicines or private prescriptions. Prescriptions to patients on discharge and to non-admitted patients in most states and territories are included, except in New South Wales and the Australian Capital Territory. 

Data are reported according to where people live, not where the prescription was written or dispensed. 

The data are age- and sex-standardised to allow comparisons between geographic areas with different age and sex structures. For more information about the data, see the Technical Note at the bottom of the page.

Opioid medicines dispensing rates fell nationally and in all states and territories between

2016–17 and 2020–­21.

National trends 

• There was an 18% decrease in the opioid medicines dispensing rate, that is the number of prescriptions dispensed per 100,000 people.
• The biggest decline occurred in 2020–21.
• There was a 14% decrease in the number of people per 100,000 people dispensed at least at least one PBS prescription dispensed for an opioid medicine. 
• There was a 30% decrease in the overall volume of opioid medicines supplied on any given day, as measured by Australian rate of defined daily doses dispensed per 1,000 people per day. (Defined daily dose is the assumed average maintenance dose per day for a drug used for its main indication in adults.)
• There was little change in the magnitude of variation: the number of prescriptions dispensed was around five times higher in the area with the highest rate compared to the area with the lowest rate. 

State trends

• Opioid medicines dispensing rates fell in all states and territories. The largest decrease was in Victoria (23%) and the smallest decrease was in the Australian Capital Territory (11%).
• Tasmania had the highest dispensing rate of any state and territory in both 2016–17 (76,697 prescriptions dispensed per 100,000 people) and 2020–21 (60,587 prescriptions dispensed per 100,000 people).
• The Northern Territory had the lowest dispensing rate of any state and territory in both 2016–17 (36,932 prescriptions dispensed per 100,000 people) and 2020–21 (32,360 prescriptions dispensed per 100,000 people).

Remoteness

• Dispensing rates were generally higher in inner and outer regional areas than in major cities or remote areas for each of the five years.

Socioeconomic disadvantage

• Dispensing rates increased with socioeconomic disadvantage for each of the five years.

Primary Health Networks

• Dispensing rates decreased in all PHNs over the five-year period.
• Gippsland PHN in Victoria had the highest PHN rate in 2016­–17 (87,917 prescriptions dispensed per 100,000 people) and Darling Downs and West Moreton PHN in Queensland had the highest PHN rate in 2020–21 (68,534 per 100,000 people).
• Northern Sydney PHN in New South Wales had the lowest rate PHN rate in both 2016–17 (28,823 prescriptions dispensed per 100,000 people) and 2020–21 (22,703 per 100,000 people).

Consistently high and low local areas

Local areas (SA3s) with consistently high opioid medicines use are those areas with rates in the top 10% for each of the five years:

• 22 out of the 340 SA3s in Australia had consistently high rates.
• 16 out of the 22 were in inner and outer regional areas (Victoria, Queensland, South Australia and Tasmania), five were in major cities (Queensland and South Australia) and one was a remote area (New South Wales).
• 21 of the 22 were in areas of socioeconomic disadvantage (lowest two SES quintiles).

SA3s with consistently low opioid medicines use are those areas with rates in the bottom 10% for each of the five years:

• 26 out of the 340 SA3s in Australia had consistently low rates.   
• 24 of the 26 were in major cities; the other two were in remote areas.
• 21 of the 26 were in areas of socioeconomic advantage (top two SES quintiles).

The 18% decrease in the dispensing rate nationally between 2016–17 and 2020–21 reversed the trend seen in the Third Atlas, which recorded a 5% increase between 2013–14 and 2016–17.

The data also show a 30% reduction in the overall volume of opioid medicines dispensed on any given day (defined daily dose per 1,000 people per day) compared to Third Atlas data, which showed little change in this measure before 2016–17.

While the dispensing rate is falling nationally and in all states and territories, there has been little change in the magnitude of variation. The data continue to show higher rates of prescribing in regional areas and in areas with socioeconomic disadvantage.

Although the relationship between high dispensing rates and areas of greater disadvantage is not clear, factors that may contribute to the higher rates in regional areas and areas with socioeconomic disadvantage include:

• Reduced access to multidisciplinary pain services and pain specialists,^13,14 although virtual health care has improved access
• Poorer health outcomes, due to illness and injuries that may require use of opioid medicines¹⁵
• Higher hospitalisations for physical injury.¹⁶

While Tasmania had the highest dispensing rate of all states and territories, it recorded a 21% reduction in dispensing between 2016–17 and 2020–21, which was higher than the average reduction across Australia (18%). Factors that may have contributed to higher dispensing rates in Tasmania include socioeconomic disadvantage and the high proportion of regional local areas in the state.

The lower rates of opioid medicines dispensing in the Northern Territory may be because PBS data do not capture medicines that are supplied through remote Aboriginal health services. See the Technical Note at the bottom of the page for more information.

The Australian Commission on Safety and Quality in Health Care (the Commission) has had a sustained focus on opioid medicines, including reporting prescription dispensing rates in the Atlas series and recommending a wide range of actions to improve the appropriateness of opioid medicines use.¹¹

Efforts to reduce the inappropriate use of opioid medicines in Australia have included regulatory changes, updated guidelines, safety warnings, education and policy changes.¹¹

It is important to note that codeine-containing products previously available over the counter became available on prescription only in February 2018. The 18% reduction in opioid medicines dispensing occurred despite all codeine-containing products being available only on prescription for more than three years of the time series period.

Changes and initiatives that may have influenced the time series data over the past five years are discussed below.

Government review and reform

Policy changes appear to have had the greatest impact on opioid medicines use. In April 2020, the TGA asked opioid sponsors to register additional smaller pack sizes for immediate-release prescription products³ and there was a complementary PBS change in June 2020.¹ There was a sharp drop in prescription dispensing after these changes.

The TGA and PBS implemented further changes that may have contributed to the reduction in opioid use, including:^1,17

• Additional warning statements in prescribing information
• Updated prescribing indications to encourage more selective use of opioids for chronic non-cancer pain
• Increased quantities/repeats only by authority approval
• Requirement for a second opinion for any patient who is taking, or who is expected to take, opioids for more than a year.

The TGA conducted a communication and education program for consumers and health professionals about the regulation changes that may have contributed to reduced dispensing rates. Consumers viewed or accessed a range of 'safe use of opioids' resources more than 32 million times, while health professionals accessed educational resources and online content about the reforms more than 455,000 times.

Changes in practice

Guidelines that identified a dose of opioids above which adverse events escalate dramatically^18,19 provided a target for de-prescribing and a limit for new prescribing.

Taking opioids before surgery is one of the biggest risk factors for opioid continuation after surgery.^20,21 Research reinforced the lack of benefit of taking opioids compared with non-opioid pain relief.²² It is likely that this research contributed to fewer patients starting opioids before surgery, reducing opioid use after surgery.

Private dispensing

An increase in private market prescriptions may have contributed to the decline in PBS prescribing of opioid medicines. Private market prescriptions provide access to medicines that are approved for use in Australia but not listed on the PBS. A study of opioid prescribing in general practice in Australia between 2013 and 2018 found that private market prescriptions made up just 6% of prescription opioid use in Australia, but that the market share was growing.¹⁴

Multidisciplinary pain services

Timely and coordinated multidisciplinary pain services covering physical, psychological and medicines treatment are best practice for people with persistent pain.¹³ Attendance at multidisciplinary pain services is associated with opioid cessation. An Australian study showed that 27% of patients attending pain services had stopped using opioids and 20% had reduced their dose by at least 50% by the end of their treatment.⁶

An additional 41 pain services were established in Australia between 2008 and 2018, taking the total to 109 and increasing the number of new referrals able to be seen each year by 15%.¹³

However, there is uneven distribution of multidisciplinary pain services across Australia and still not enough to meet demand. For example, there is only one pain service in Tasmania.¹³ Median wait times for pain services in many parts of Australia continue to be longer than the recommended maximum wait of six months and are longest for services offering multidisciplinary care.¹³

COVID-19 and elective surgery

A decrease in elective surgery due to COVID-19 restrictions may have reduced the dispensing of opioids at hospital discharge.²³

Prescriber monitoring

In 2018, the Australian Government Chief Medical Officer sent letters to more than 4,500 GPs who were in the top 20% of prescribers of opioids. The ‘nudge’ letters highlighted the GPs’ high prescribing in comparison to their peers and prompted them to change their prescribing when it was safe and appropriate. An evaluation found that metropolitan GPs who were sent the letter reduced their opioids prescribing by 6% compared to a group of high prescribers who did not receive the letter.²⁴

Stewardship and improvement programs

Opioid stewardship programs, which include coordinated interventions to improve, monitor and evaluate the use of opioids,²⁵ may help to reduce inappropriate prescribing. These programs include structured approaches to governance and accountability, policy, education, monitoring and improvement activities.²⁶

Examples of stewardship programs include:

• An opioid-focused practice improvement program was piloted in two Emergency Departments in 2018 as part of the Queensland Stewardship Program. It resulted in a 21% relative reduction in total oxycodone prescriptions and improved clinical handover communication at discharge.²⁵
• A quality improvement program at St Vincent’s Hospital Sydney, which included prescriber audit and feedback, achieved a rapid 40% reduction in the number of oxycodone tablets prescribed at discharge.²⁷  
• An Analgesic Stewardship Pilot Program supported best practice in acute pain management in up to 10 Victorian health services in 2021 and 2022.²⁸

Real time prescription monitoring

Real time prescription monitoring (RTPM) is the use of digital health systems to provide information to doctors and pharmacists about a patient’s use of controlled medicines.²⁹

Tasmania was the first state to implement RTPM with a program called DORA (Drugs and Poisons Information System Online Remote Access). The program, established in 2009, has contributed to a reduction in opioid-related harms in the state, including a reduction in opioid-related deaths.³⁰ 

The Australian Government has funded each state and territory to build its own RTPM database to interact with the National Data Exchange, which it established in 2018.²⁹

Victoria established its SafeScript program in 2020,³¹ which may have contributed to the state recording the biggest reduction in opioid medicine dispensing rates of all states and territories. Other states and territories have started or are planning their own RTPM programs.

Pain management educational programs

The Veterans' Medicines Advice and Therapeutics Education Services project (Veterans' MATES) aims to improve the use of medicines and health services in the veteran community. It uses administrative claims data to identify Department of Veterans’ Affairs (DVA) clients who are at risk of medicine-related problems. It provides feedback to treating doctors and health services about the treatment they provide to DVA clients. The program has provided consumer resources on topics including chronic pain and recovering from pain.³²

NPS MedicineWise implemented national programs in 2015 and 2019 to improve the quality use of opioids and reduce associated harms for people with chronic non-cancer pain who are managed in primary care. The programs involved general practice education visits, clinical audit tools, PBS/MBS feedback reports, and a range of resources for health professionals and consumers. In 2021, NPS MedicineWise started work on the quality use of medicines in acute pain.

The Tasmania Health Service has implemented educational programs to improve the prescribing of opioid medicines, including a campaign to encourage clinicians to consider dispensing smaller quantities of opioids at discharge, and online education for all staff involved in the management of opioid medicines.

National strategies

The Australian Government’s first National Strategic Action Plan for Pain Management sets out priority actions to improve access to, and knowledge of, best practice pain management.³³ The actions are based around the themes of coordination and leadership; care; implementation; research; prevention and support.

Obesity is often associated with chronic pain.³³ The National Strategic Action Plan for Pain Management includes options for preventing chronic pain, including strategies such as reducing the prevalence of obesity through increased physical activity and recognising the role of nutrition.³³

The National Preventive Health Strategy 2021–2030 also sets out actions to reduce the risks of poor health and disease, including reducing harms related to alcohol and other drugs.³⁴

Although these findings are encouraging, a continued focus on reducing the inappropriate prescribing of opioid medicines is warranted because of the harms of opioid medicines and continued variation in dispensing. Options for further action are discussed below.

Shared care between health professionals and pain services

Multidisciplinary pain services are well positioned to support and offer advice to GPs and other health professionals, such as pharmacists, on the evidence-based care of patients with chronic non-cancer pain.  

Shared decision-making

Shared decision-making is central to the appropriate use of opioid medicines. Options for managing pain should be discussed with a patient and their carer in a way that that leads to a shared understanding of the decision to use an opioid analgesic or other treatment.³⁵ Patients, and their family or carer, should be informed about the potential benefits and harms of acute pain treatment options so that they can participate in decision-making about their treatment with their clinician.

Regional focus

An increased focus on initiatives in regional areas may help to improve the appropriate use of opioid medicines. Initiatives could include improving access to specialist pain management services.

Prescriber and consumer education

Increased prescriber and consumer awareness of the regulatory changes around opioid medicines may decrease inappropriate use. The TGA found that only 40% of prescribers³⁶ and 20% of consumers were aware of the reforms in 2021.³⁷ The report also found that only 52% of consumers who were taking opioid medicines knew they were taking an opioid medicine, while 59% reported that they were using opioids safely and 76% believed their opioid medicine was effective.³⁷

Continued efforts to educate prescribers of opioid medicines about appropriate use should include GPs as well as hospital doctors, who should consider weaning and cessation plans at the time of initial prescribing of opioid medicines for acute pain in hospitals.

Education in safe de-prescribing is important. The Royal Australasian College of Physicians recommends that clinicians should weigh up the potential consequences of de-prescribing for each patient.³⁸ Abrupt de-prescribing or rapid tapering can lead to physical and psychological harms, including untreated pain. The College recommended that prescribers must consider each patient’s unique circumstances and work compassionately with them to minimise opioid-related harms.³⁸

GPs should be supported to develop an appropriate de-prescribing schedule for each patient. This support could include pain services providing a GP advisory service and education about de-prescribing opioids safely.

New approaches to managing pain

Recent evidence supports the use of brain retraining tools, such as cognitive behavioural therapy, mindfulness, and graded exposure or imagery, to manage persistent pain.³⁹

The results of two small randomised controlled trials in 2021 suggest brain retraining techniques are most effective when used in combination. The trials tested strategies comprising at least four techniques for brain retraining: pain neuroscience education; graded exposure or imagery; cognitive therapy and emotional regulation; and stress reduction therapy. More than 50% of participants were pain free or near pain free at six months.^40,41

Opioid Analgesic Clinical Care standard

The Commission, in conjunction with the TGA, launched the Opioid Analgesic Stewardship in Acute Pain Clinical Care Standard³⁵ in April 2022. The standard provides guidance to ensure the appropriate use and review of opioid analgesics for the management of acute pain.

As well as the actions above, members of the expert advisory group for this report have proposed a variety of options to support the appropriate use of opioid medicines:

Pain services

• Increase investment in pain services and allied health services, especially in under-served rural and regional areas
• Expand transitional care services to bridge the gaps in care between GPs and acute care settings.

Prescriber education and support

• Improve support for GPs through better communication of analgesic plans from hospitals
• Develop capacity for an ‘advice step’ before GPs refer a patient to a specialist pain service. This would be similar to the UK NHS’s ‘advice and guidance’ program, which allows GPs to seek advice from another clinician before or instead of referral⁴²
• Further encourage virtual health services for pain management.

Prescribing clarification

• The TGA, in collaboration with professional groups, should define the ‘exceptional’ circumstances in which opioid medicines can be used for chronic non-cancer pain.

Medication monitoring

• Encourage the use of My Health Record and medical software such as Best Practice to monitor opioid medicines use.

• Opioid Analgesic Stewardship in Acute Pain Clinical Care Standard,³⁵ Australian Commission on Safety and Quality in Health Care
• Chronic pain and the bigger picture, NPS MedicineWise prescriber resources
• Starting a conversation about opioid tapering with patients - Practice tips for GPs and pharmacists,⁴³ NPS MedicineWise
• Opioid medicines and chronic non-cancer pain, NPS MedicineWise consumer resources
• Lowering your opioid dose,⁴⁴ NPS MedicineWise tapering action plan for consumers
• Clinician information sheet on opioid analgesic tapering: summary,⁴⁵ Therapeutic Goods Administration
• Chronic Pain Toolkit for Clinicians, NSW Agency for Clinical Innovation
• Better Pain Management, Faculty of Pain Management, Australian and New Zealand College of Anaesthetists, online learning modules

1. Therapeutic Goods Administration. Prescription opioids: Information for health professionals. Canberra: TGA; 2021 [Available from: https://www.tga.gov.au/prescription-opioids-information-health-professionals. Accessed April 2022].
2. Currow DC, Phillips J, Clark K. Using opioids in general practice for chronic non-cancer pain: an overview of current evidence. Med J Aust. 2016;205(7):334-5.
3. Wiese AD, Grijalva CG. The use of prescribed opioid analgesics and the risk of serious infections. Future Microbiol. 2018;13:849-52.
4. Australian Institute of Health and Welfare. Opioid harm in Australia and comparisons between Australia and Canada. Canberra: AIHW; 2018.
5. Therapeutic Guidelines. The role of opioids in chronic noncancer pain. Pain and Analgesia. In: eTG Complete [Internet]. Melbourne: Therapeutic Guidelines Limited; 2020.
6. Tardif H, Hayes C, Allingham SF. Opioid cessation is associated with reduced pain and improved function in people attending specialist chronic pain services. Med J Aust. 2021;214(9):430-2.
7. Penington Institute. Australia's annual overdose report. Penington Institute: Melbourne; 2021.
8. Lalic S, Ilomaki J, Bell JS, Korhonen MJ, Gisev N. Prevalence and incidence of prescription opioid analgesic use in Australia. Br J Clin Pharmacol. 2019;85(1):202-15.
9. Schug SA PG, Scott DA, Alcock M, Halliwell R, Mott JF. Acute Pain Management: Scientific Evidence. Melbourne: Australian and New Zealand College of Anaesthetists; 2020.
10. The Society of Hospital Pharmacists of Australia. Reducing opioid related harm. SHPA; 2018.
11. Australian Commission on Safety and Quality in Health Care and Australian Institute of Health and Welfare. The Third Australian Atlas of Healthcare Variation. Sydney: ACSQHC; 2018.
12. OECD. OECD Indicators; Health at a Glance 2021. Paris: OECD; 2021.
13. Hogg MN, Kavanagh A, Farrell MJ, Burke ALJ. Waiting in Pain II: An Updated Review of the Provision of Persistent Pain Services in Australia. Pain Med. 2021;22(6):1367-75.
14. Busingye D, Daniels B, Brett J, Pollack A, Belcher J, Chidwick K, et al. Patterns of real-world opioid prescribing in Australian general practice (2013-18). Aust J Prim Health. 2021;27(5):416-24.
15. Australian Institute of Health and Welfare. Australia's Health 2020: AIHW; 2020 [Available from: https://www.aihw.gov.au/reports-data/australias-health].
16. Australian Institute of Health and Welfare. Hospitalised injury and socioeconomic influence in Australia 2015–16. Canberra: AIHW; 2019.
17. Pharmaceutical Benefits Scheme. Revised opioids PBS listings for the management of severe disabling pain 2020 [Available from: https://www.pbs.gov.au/news/2020/05/opioids-factsheet-files/opioids-factsheet-2020-v2.pdf].
18. NSW Agency for Clinical Innovation. Quick steps through opioid management 2022 [Available from: https://aci.health.nsw.gov.au/chronic-pain/health-professionals/quick_steps_through_opioid_management].
19. Faculty of Pain Medicine; Australian and New Zealand College of Anaesthetists. Statement regarding the use of opioid analgesics in patients with chronic non-cancer pain. [Available from: https://www.anzca.edu.au/getattachment/7d7d2619-6736-4d8e-876e-6f9b2b45c435/PS01(PM)-Statement-regarding-the-use-of-opioid-analgesics-in-patients-with-chronic-non-cancer-pain]. ANZCA; 2021.
20. Lawal OD, Gold J, Murthy A, Ruchi R, Bavry E, Hume AL, et al. Rate and Risk Factors Associated With Prolonged Opioid Use After Surgery: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(6):e207367.
21. Inacio MC, Hansen C, Pratt NL, Graves SE, Roughead EE. Risk factors for persistent and new chronic opioid use in patients undergoing total hip arthroplasty: a retrospective cohort study. BMJ Open. 2016;6(4):e010664.
22. Krebs EE, Gravely A, Nugent S, Jensen AC, DeRonne B, Goldsmith ES, et al. Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial. JAMA. 2018;319(9):872-82.
23. Australian Institute of Health and Welfare. Elective surgery activity: AIHW; 2021 [Available from: https://www.aihw.gov.au/reports-data/myhospitals/intersection/activity/eswt].
24. Department of Health. Opioid Prescribing Practices Project: Key Outcomes. Canberra: Commonwealth of Australia; 2021.
25. Clinical Excellence Commission Queensland Health. Queensland Opioid Stewardship Program (QOSP). Brisbane: Queensland Health; 2022 [Available from: https://clinicalexcellence.qld.gov.au/improvement-exchange/queensland-opioid-stewardship-program-qosp].
26. Bui T, Bortz H, Cairns KA, Graudins LV, Corallo CE, et al. AAA stewardship: managing high-risk medications with dedicated antimicrobial, anticoagulation and analgesic stewardship programs. J Pharm Pract Res. 2021;51(4):342-7.
27. Stevens J, Trimboli A, Samios P, Steele N, Welch S, Thompson P, et al. A sustainable method to reduce postoperative oxycodone discharge prescribing in a metropolitan tertiary referral hospital. Anaesthesia. 2019;74(3):292-9.
28. Safer Care Victoria. Analgesic stewardship pilot program information pack Melbourne: Safer Care Victoria; 2021 [Available from: https://www.safercare.vic.gov.au/sites/default/files/2021-09/Analgesic%20stewardship%20information%20pack.pdf].
29. Australian Government Department of Health. National Real Time Prescription Monitoring (RTPM) Canberra: Australian Government; 2022 [Available from: https://www.health.gov.au/initiatives-and-programs/national-real-time-prescription-monitoring-rtpm].
30. Boyles P. Real-time prescription monitoring: lessons from Tasmania. Aust Prescr. 2019;42(2):48-9.
31. Victorian Department of Health. SafeScript Melbourne: Victorian Dept of Health; 2022 [Available from: https://www.health.vic.gov.au/drugs-and-poisons/safescript].
32. Department of Veterans' Affairs. What is Veterans’ MATES? Canberra: Australian Government; 2018 [Available from: https://www.veteransmates.net.au/what-is-veterans-mates].
33. Australian Government Department of Health. National Strategic Action Plan for Pain Management. Canberra: Australian Government; 2021.
34. Australian Government Department of Health. National Preventive Health Strategy 2021–2030. Canberra: Australian Government; 2021.
35. Australian Commission on Safety and Quality in Health Care. Opioid Analgesic Stewardship in Acute Pain Clinical Care Standard  – Acute care edition. Sydney: ACSQHC; 2022.
36. ORIMA Research. Australian Government Department of Health – Therapeutic Goods Administration. Key findings from tracking research relating to opioid regulatory reforms and communications: Prescribers. ORIMA Research; 2022.
37. ORIMA Research. Australian Government Department of Health – Therapeutic Goods Administration. Key findings from tracking research relating to opioid regulatory reforms and communications: Consumers. ORIMA Research; 2022.
38. The Royal Australasian College of  Physicians; Australasian Chapter of Addiction Medicine. Evolve Top-5 Recommendations on low-value practices. 2020 [Available from: https://evolve.edu.au/docs/default-source/default-document-library/ANZSN.pdf?sfvrsn=ecd42c74_8].
39. Veterans' MATES. Change the persistent pain experience: Focus on improving function and pain education. Canberra: Australian Government Department of Veterans' Affairs; 2022.
40. Ashar YK, Gordon A, Schubiner H, Uipi C, Knight K, Anderson Z, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial. JAMA Psychiatry. 2022;79(1):13-23.
41. Donnino MW, Thompson GS, Mehta S, Paschali M, Howard P, Antonsen SB, et al. Psychophysiologic symptom relief therapy for chronic back pain: a pilot randomized controlled trial. Pain Rep. 2021;6(3):e959.
42. NHS. Advice and Guidance. United Kingdom: NHS;  [Available from: https://www.england.nhs.uk/elective-care-transformation/best-practice-solutions/advice-and-guidance/].
43. NPS MedicineWise. Starting a conversation about opioid tapering with patients - Practice tips for GPs and pharmacists Sydney: NPS MedicineWise; 2019 [Available from: https://www.nps.org.au/assets/NPS_MedicineWise_Opioids_Conversation_Starter_FINAL.pdf].
44. NPS MedicineWise. Lowering your opioid dose. Sydney: NPS MedicineWise; 2019 [Available from: https://www.nps.org.au/assets/NPS-MedicineWise-Lowering-your-opioid-dose.pdf].
45. Therapeutic Goods Administration. Clinician information sheet on opioid analgesic tapering: summary Canberra: TGA; 2020 [Available from: https://www.tga.gov.au/resource/clinician-information-sheet-opioid-analgesic-tapering-summary].