Uptake of methylnaltrexone in Australian patients with opioid-induced constipation: a review of the number of prescriptions presented in the first 12 months of subsidisation

Clark, K; Rowett, D; Robinson, M; Currow, DC

Uptake of methylnaltrexone in Australian patients with opioid-induced constipation: a review of the number of prescriptions presented in the first 12 months of subsidisation

Clark, K Rowett, D Robinson, M Currow, DC

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Publication Type:: Journal Article
Citation:: BMJ supportive & palliative care, 2013, 3 (1), pp. 98 - 102
Issue Date:: 2013-03-01

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Field	Value	Language
dc.contributor.author	Clark, K	en_US
dc.contributor.author	Rowett, D	en_US
dc.contributor.author	Robinson, M	en_US
dc.contributor.author	Currow, DC https://orcid.org/0000-0003-1988-1250	en_US
dc.date.issued	2013-03-01	en_US
dc.identifier.citation	BMJ supportive & palliative care, 2013, 3 (1), pp. 98 - 102	en_US
dc.identifier.uri	http://hdl.handle.net/10453/116436
dc.description.abstract	BACKGROUND: Disturbed bowel habits are very common in palliative care patients, most commonly thought to be due to opioid use. The peripheral opioid-antagonist methylnaltrexone has been subsidised in Australia to ensure that palliative care patients have timely and equitable access to this medication. The aim of this paper is to describe the use of methylnaltrexone in the first year after it was subsidised for palliative care, in particular focusing on the actual use of this medication compared with predicted need.METHODS: The predicted need for methylnaltrexone was calculated using an epidemiological approach based on data collected by the Australian Institute of Health and Welfare to determine the number of Australian deaths annually. A single source of data was used to determine the number of patients who die while under the care of palliative services in Australia (National Census of Palliative Care Services, 1999). These figures allowed the number of people likely to be receiving opioids to be estimated and therefore the number who could potentially benefit from methylnaltrexone.RESULTS: The number of patients who might benefit was calculated to be 5000, which contrasts with the 261 actual prescriptions written for methylnaltrexone. Even more striking was the disparity between initial prescriptions and the 93 requests for ongoing use.CONCLUSIONS: These data highlight much lower use of methylnaltrexone than predicted and raise a number of questions including the fact that the palliative care literature emphasises opioids as the dominant cause of constipation in palliative care patients given little ongoing use of methylnaltrexone.	en_US
dc.relation.ispartof	BMJ supportive & palliative care	en_US
dc.relation.isbasedon	10.1136/bmjspcare-2012-000284	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Constipation	en_US
dc.subject.mesh	Naltrexone	en_US
dc.subject.mesh	Analgesics, Opioid	en_US
dc.subject.mesh	Narcotic Antagonists	en_US
dc.subject.mesh	Palliative Care	en_US
dc.subject.mesh	Needs Assessment	en_US
dc.subject.mesh	Australia	en_US
dc.subject.mesh	Quaternary Ammonium Compounds	en_US
dc.subject.mesh	Prescriptions	en_US
dc.title	Uptake of methylnaltrexone in Australian patients with opioid-induced constipation: a review of the number of prescriptions presented in the first 12 months of subsidisation	en_US
dc.type	Journal Article
utslib.citation.volume	1	en_US
utslib.citation.volume	3	en_US
utslib.for	1110 Nursing	en_US
utslib.for	1117 Public Health and Health Services	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/IMPACCT
utslib.copyright.status	closed_access
pubs.issue	1	en_US
pubs.publication-status	Published	en_US
pubs.volume	3	en_US

Abstract:

BACKGROUND: Disturbed bowel habits are very common in palliative care patients, most commonly thought to be due to opioid use. The peripheral opioid-antagonist methylnaltrexone has been subsidised in Australia to ensure that palliative care patients have timely and equitable access to this medication. The aim of this paper is to describe the use of methylnaltrexone in the first year after it was subsidised for palliative care, in particular focusing on the actual use of this medication compared with predicted need.METHODS: The predicted need for methylnaltrexone was calculated using an epidemiological approach based on data collected by the Australian Institute of Health and Welfare to determine the number of Australian deaths annually. A single source of data was used to determine the number of patients who die while under the care of palliative services in Australia (National Census of Palliative Care Services, 1999). These figures allowed the number of people likely to be receiving opioids to be estimated and therefore the number who could potentially benefit from methylnaltrexone.RESULTS: The number of patients who might benefit was calculated to be 5000, which contrasts with the 261 actual prescriptions written for methylnaltrexone. Even more striking was the disparity between initial prescriptions and the 93 requests for ongoing use.CONCLUSIONS: These data highlight much lower use of methylnaltrexone than predicted and raise a number of questions including the fact that the palliative care literature emphasises opioids as the dominant cause of constipation in palliative care patients given little ongoing use of methylnaltrexone.

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http://hdl.handle.net/10453/116436