In the previous episode we talked about the science of pain, opioid analgesia and dependence. Now we look at the influence of culture, regulation and marketing on opioid prescribing for chronic non-cancer pain. First we ask which are the prescription opioids most commonly leading to dependence and why are they prescribed. Then we discuss the mixed messages that prescribers are getting from guidelines and pharmaceutical regulation. Ever-relaxing indications for pharmaceutical subsidies can nudge prescribing behaviour in the wrong direction.Tasmania was for many years the worst performer on measures of opioid use and harm, but this all began to turn around from 2006. Addiction medicine specialist Professor Adrian Reynolds explains how education, regulation and real-time prescription monitoring were brought together in that state.Finally, an undeniable influencer of prescribing behaviour are the promotional campaigns organised by pharmaceutical companies. Pain medicine specialist Chris Hayes explains that those within the medical profession will not be surprised by this, but can be vigilant about having their professional judgement compromised. A couple of case studies provide context for the RACP's Guidelines for ethical relationships between health professionals and industry.Guests Dr Christopher Hayes FFPMANZCA (Director Hunter Integrated Pain Service) Clin Assoc Prof Adrian Reynolds FAChAM (Clinical Director Alcohol and Drug Service, Tasmania)Production Written and produced by Mic Cavazzini. Music: Chris Zabriskie ‘Out of the Skies, Under the Earth’ and ‘What True Self Feels Bogus Lets Watch Jason X’; Borrtex 'You Are Not Alone', Jahzzar 'Missing You' courtesy of Free Music Archive. Gunnar Johnsén, 'Task At Hand 2', 'Task At Hand 5' licenced from Epidemic Sound. Image courtesy of WikiCommons. Voice acting by Iain Muir, Bob Kotic and Phillipe Soulaine.Editorial feedback for this episode was provided by members of the RACP’s Podcast Editorial Group; Stella Sarlos, Lisa Mounsey, Michael Herd, Atif Slim, Rhiannon Mellor, Leah Krischock, Angela Chen, Genevieve Yates, Adrienne Torda, Philip Gaughwin, Rosalynn Pzcsola, Nele Legge, Marion Leighton, Oscar Russell, Jenae Valk, Li-Zsa Tan, Alan Ngo, Leah Krischock, Seema Radhakrishnan Please visit the RACP website for a transcript embedded with citations. Fellows of the College can claim CPD credits for listening and additional reading.

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