For Janine Monty, life used to be very different.
Despite having rheumatoid arthritis, she worked regular hours and ran 5km every day.
Then she was diagnosed with a disease called chronic inflammatory demyelinating polyneuropathy — the same disease Olympic swimmer Michael Klim has.
From paracetamol to surgeries, Monty said she tried a range of things to relieve the pain she was experiencing, but none were effective.
She was then as a "last resort", and said they are "the only treatment that significantly reduces my pain and allow me to function".
But since 2020, Monty has been forced to take a lower dose, which she says has made life harder.
"I can no longer work, no longer exercise intensely, I am no longer fit and strong", she said.
"I no longer have any social life or any relationships. I live in isolation and poverty because my opioid dose was lowered."
The 'eye-opening' moment that sparked change
The lower dosage is the result of rule changes to the prescription and supply of opioids in 2020.
For pain relief medications on the Pharmaceutical Benefits Scheme (PBS) — like or Codeine — restrictions were introduced on the number of repeat prescriptions allowed, half-sized packs were brought in for those needing pain relief after surgery, and mandatory ceilings were placed on the dosage GPs were allowed to prescribe.
Dr Danielle McMullen is a GP and vice president of the the Australian Medical Association.
She said the changes were the result of concern from regulators.
There were rule changes to the prescription and supply of opioids like Oxycodone in 2020. Source: Getty / BackyardProduction
"That was eye-opening to many I think, and part of that impetus to change that regulatory environment, and make sure that we were having that conversation about shifting the dial and appropriate use of opiates," McMullen said.
"Making sure that we’re reserving their use for when we really need them, and not contributing to overuse or misuse or dependence in the population."
Dr Ben Daniels from the University of NSW is the senior co-author of a new study, published in the Medical Journal of Australia, that suggests these new rules have been effective.
"The primary finding was that overall the use of opioids accessed through the PBS — so publicly subsidised opioids — they decreased following this tightening of prescribing restrictions around opioids," Daniels said.
"We do believe that there was a true reduction in the amount of opioids that were prescribed."
Daniels sees this as a good thing, but for those with chronic pain, like Janine, it’s just made things worse.
Gender differences in chronic pain — and how many are affected
The number of people affected is vast.
An estimated 3.4 million Australians live with chronic pain, with more than half of that group being women. Around 68 per cent are of working age, most commonly in their 40s or 50s.
"While people do want to keep up with the latest findings and understandings when you take something away — when there is no replacement — it just creates distress," said Guilia Jones, the CEO of advocacy group Pain Australia.
"So while we accept that there needed to be some changes, the way it was done was not really appropriate, and the outcome is a very distressed cohort who were pretty distressed already."
An estimated 3.4 million Australians live with chronic pain, with more than half of that group being women. Source: Getty
"Because chronic pain doesn't have a simple solution, people often get treated like they are the problem," she said.
"So they'll go to a doctor who doesn't quite know what to do with them and they'll be asked if they're making it up, it'll be assumed that they're trying to drug seek."
Opioids not a long-term solution
McMullen says opioids aren't meant to be a long-term answer to pain, and the risks of harm can start to outweigh the benefits after a while.
She says GPs can provide access to alternative therapies through chronic disease management plans, with rebates available for mental health consultations, exercise physiologists, and physiotherapists who can support the recovery process.
McMullen said she understands that for some patients and doctors, access and affordability make it a challenge. She said that’s why the AMA has been pushing for better general practice funding to provide wraparound care.
But for Jones, the damage is already done.
She wants to see cultural change — and advancements in how chronic pain is addressed.
“It’s a very young area of medicine in many ways," she said.
"It was really only in the '70s and '80s that people started looking at this area. Australia has been at the forefront, but we haven’t had the breakthrough on how to manage this that’s been needed.
"We have a lot to celebrate in Australia, but the opioid issue, the crisis of misuse versus appropriate use — they are two distinct issues and we have to deal with them separately."
