ORIGINAL REPORT Opioid analgesic prescribing in Australia: a focus on gender and age Samantha A. Hollingworth 1 * , Paul D. Gray 2,3 , Wayne D. Hall 4 and Jake M. Najman 5 1 School of Pharmacy, The University of Queensland, Woolloongabba, QLD, Australia 2 The Professor Tess Cramond Multidisciplinary Pain Centre, Royal Brisbane and Woman’s Hospital, Herston, QLD, Australia 3 School of Medicine, The University of Queensland, Herston, QLD, Australia 4 Centre for Youth Substance Abuse Research, The University of Queensland, Herston, QLD, Australia 5 School of Public Health & School of Social Sciences, The University of Queensland, Herston and St Lucia, QLD, Australia ABSTRACT Purpose The use of prescription opioid analgesics has been increasing over the last few decades in Australia. In particular, oxycodone and fentanyl have increased substantially. We examined the gender and age trends in the prescribing of subsidised opioid analgesics in the Australian population for non-palliative care indications. Methods We analysed the Medicare Australia and Drug Utilisation Sub-Committee databases for prescription data from 2002 to 2009 in 10-year age groups and by gender. Prescriptions were converted to Defined Daily Doses (DDD)/1000/day using Australian Bureau of Statistics population data. Results Overall use increased progressively in 2002–2009 from 12.95 to 16.08 DDD/1000 population/day (average annual increase 3.4%). Codeine was the most widely used agent followed by tramadol then oxycodone. Dispensed use increased in those aged in their 20s and 30s to plateau between 30 and 59 years for the three most preferred analgesics. The peak use of higher dose formulations of oxycodone was seen in males from 40 years. The highest dose formulation of tramadol was preferred in those aged up to approximately 70 years. Conclusions Reasons for increased use may include increased prevalence of people with cancer and use for acute pain. The overall benefit and risk in this escalation of opioid use are difficult to determine; however, the increasing risk of tolerance, dependence, overdose and drug diversion suggests to clinicians and policy makers that this escalation may not be in the best interest of all Australians. Copyright © 2015 John Wiley & Sons, Ltd. key words—analgesics; opioids; oxycodone; fentanyl; prescribing; pharmacoepidemiology Received 10 March 2014; Revised 26 January 2015; Accepted 14 February 2015 INTRODUCTION Pain is a major problem in Australia and is generally classified into three main types: acute pain, chronic non-malignant pain (CNMP) and cancer pain. Chronic pain, defined as pain experienced every day for 3 months in the 6 months prior to interview, was reported by 17% of males and 20% of females in a representative sample of more than 17,000 people living in New South Wales (NSW). 1 In males, pain prevalence was highest (27%) for those in their late 60s, while it was highest (31%) in females in their early 80s. Chronic pain was significantly associated with older age, female gender, lower levels of com- pleted education and not having private health insurance. It was also associated with high levels of psychological distress and markers of social disadvan- tage. 1,2 Similar prevalence of chronic pain was found in an Australia-wide survey of 250 general practi- tioners (GP). Of those sampled, 197 GPs returned the surveys containing a sample of 5,793 patients. There was an overall prevalence of chronic pain of 15.7% after adjusting for visit frequency. The prevalence of chronic pain was again associated with increasing age, but in this survey there was no gender difference in prevalence. 3 Analgesia can be prescribed or obtained directly over-the-counter (OTC) by the patient. The use of OTC analgesics in Australia is significant and includes paracetamol and non-steroidal antiinflammatory drugs *Correspondence to: S. A. Hollingworth, School of Pharmacy, The University of Queensland, 20 Cornwall Street, Woolloongabba, QLD 4102, Australia. E-mail: s.hollingworth@uq.edu.au Copyright © 2015 John Wiley & Sons, Ltd. pharmacoepidemiology and drug safety (2015) Published online in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/pds.3767