Patients presenting with pain are frequently seen in primary care in New Zealand. Treatment for pain will vary depending on the
underlying cause but can usually be based on the WHO analgesic ladder. It is important that patients understand which medicines they
have been prescribed to reduce their pain and how they should be taken, by providing a clear analgesic plan.
Most patients will be prescribed Step one medicines (paracetamol and/or an NSAID). Weaker opioids, e.g. codeine and tramadol are at Step 2
and strong opioids such as morphine are Step 3 on the analgesic ladder. Opioid medicines remain one of the most commonly prescribed medicine
classes in New Zealand accounting for approximately 10% of all prescriptions dispensed in 2017.1
This report provides an overview of opioid analgesic prescribing trends nationally and for your practice over the last five years.
We have included some key points for reflection (see side panel).
1. Ministry of Health, Pharmaceutical collection, 2017.
National data - trends in use
Overall, use of all opioid analgesics has remained relatively stable over the past five years with approximately one-fifth of the population receiving
a dispensing in a year. The opioids classified as Step 2 on the WHO analgesic ladder, e.g. codeine and tramadol, had much higher overall use than the Step 3
opioids, e.g. morphine and oxycodone. Tramadol use has increased by 13% (Figure 1). Morphine use increased by 20%, while oxycodone use has levelled out
after decreasing between 2013 – 2015 (Figure 2). It is difficult to state accurately why these changes have occurred because the pharmaceutical data
does not include the indication for which the medicines were prescribed. It is likely that multiple factors influence prescribing and may include our
ageing population, education around appropriate medicine use and subsidy changes.
Step 2 opioids prescribed nationally
Figure 1. Use of Step 2 opioid analgesics (number of patients/1000 population) from 2013-2017.*
* Methadone has been removed from the analyses because it is predominantly used for indications other than analgesia
Step 3 opioids prescribed nationally
Figure 2. Use of Step 3 opioid analgesics (number of patients/1000 population) from 2013-2017.*
* Methadone has been removed from the analyses because it is predominantly used for indications other than analgesia
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WHO analgesic ladder - Data for your practice
The World Health Organisation (WHO) analgesic ladder is widely accepted for the management of nociceptive pain. The
general principle is to escalate and de-escalate through the ladder, as required until pain is negligible.
See "The
principals of managing acute pain in primary care" for further information.
In 2017, patients ( of your practice population) had a prescription for any opioid analgesic. Ideally, patients who received a prescription for a strong opioid would also
have received a prescription for a weak opioid, as analgesic treatment was escalated or de-escalated.
Your data show that in 2017, of the patients who received a strong opioid (Step 3), % were also prescribed a weak opioid (Step 2) within three months. If this percentage is low, you may like
to consider this analgesic strategy, depending on clinical circumstances; it may not be applicable for patients receiving palliative care treatment.
Step 2 analgesics prescribed at
Step 3 analgesics prescribed at
Comparing the ratio of Step 2 and Step 3 analgesics prescribed at
Download your Analgesic Update 2018 report
To download a report of your and your practice's analgesic prescribing, see: https://bpac.org.nz/mybpac/reports/
