Opioid Prescribing Changes in Advanced Cancer Before and After Withdrawal of Hydromorphone Slow‐Release Tablets

AIM: Ongoing disruptions to opioid supply in Australia have raised ongoing concerns about their impact on cancer pain management. The withdrawal of hydromorphone slow-release (SR) tablets from the Australian market has presented challenges to advanced cancer pain management. This study aimed to determine how this affected the utilisation of alternative slow-release opioids in patients with advanced cancer. METHODS: A retrospective cohort study was conducted at a quaternary cancer centre, comparing opioid prescribing patterns across two 12-month periods: before hydromorphone SR tablet discontinuation was announced and after its discontinuation. Inpatient and outpatient prescribing data were analysed for adult patients with incurable advanced or metastatic cancer who first presented to the centre during each study period. RESULTS: A total of 2856 patients were included (n = 1475 pre and n = 1381 post hydromorphone SR discontinuation). Following hydromorphone SR withdrawal, opioid prescribing patterns shifted. Methadone use rose modestly (adjusted odds ratio [aOR] 1.42, p = 0.07), accompanied by a doubling of median dose (45 mg vs. 22.5 mg; p = 0.005). Morphine use declined (aOR 0.69, p < 0.001), yet daily OMEDD increased by ∼20% (95% confidence interval 1.01-1.37). Tapentadol (aOR 1.40, p = 0.01) and buprenorphine (aOR 1.37, p < 0.001) were prescribed more frequently, without corresponding dose escalation. CONCLUSIONS: Following hydromorphone SR withdrawal, the frequency of methadone use increased and median doses doubled. Research incorporating national datasets is needed to clarify the broader impact of opioid supply interruptions. These findings indicate a potential need to reframe the place of methadone in practice, and potentially upscale the focus of clinician training on its safe and effective use.