Hundreds of thousands of people worldwide are taking drugs like Ozempic to lose weight. But what do we actually know about them? This month, The Conversation’s experts explore their rise, impact and potential consequences.

You’ve no doubt heard of Ozempic but have you heard of Wegovy? They’re both brand names of the drug semaglutide, which is currently in short supply worldwide.

Ozempic is a lower dose of semaglutide, and is approved and used to treat diabetes in Australia. Wegovovy is approved to treat obesity but is not yet available in Australia. Shortages of both drugs are expected to last throughout 2024.

Both drugs are expensive. But Ozempic is listed on Australia’s Pharmaceutical Benefits Schedule (PBS), so people with diabetes can get a three-week supply for A$31.60 ($7.70 for concession card holders) rather than the full price ($133.80).

Wegovy isn’t listed on the PBS to treat obesity, meaning when it becomes available, users will need to pay the full price. But should the government subsidise it?

Wegovy’s manufacturer will need to make the case for it to be added to the PBS to an independent advisory committee. The company will need to show Wegovy is a safe, clinically effective and cost-effective treatment for obesity compared to existing alternatives.

In the meantime, we asked five experts: when supplies resume, should governments subsidise drugs like Ozempic for weight loss?

Four out of five said yes

This is the last article in The Conversation’s Ozempic series. Read the other articles here.

Disclosure statements: Clare Collins is a National Health and Medical Research Council (NHMRC) Leadership Fellow and has received research grants from the National Health and Medical Research Council (NHMRC), the Australian Research Council (ARC), the Medical Research Future Fund (MRFF), the Hunter Medical Research Institute, Diabetes Australia, Heart Foundation, Bill and Melinda Gates Foundation, nib foundation, Rijk Zwaan Australia, the Western Australian Department of Health, Meat and Livestock Australia, and Greater Charitable Foundation. She has consulted to SHINE Australia, Novo Nordisk (for weight management resources and an obesity advisory group), Quality Bakers, the Sax Institute, Dietitians Australia and the ABC. She was a team member conducting systematic reviews to inform the 2013 Australian Dietary Guidelines update, the Heart Foundation evidence reviews on meat and dietary patterns and current co-chair of the Guidelines Development Advisory Committee for Clinical Practice Guidelines for Treatment of Obesity; Emma Beckett has received funding for research or consulting from Mars Foods, Nutrition Research Australia, NHMRC, ARC, AMP Foundation, Kellogg and the University of Newcastle. She works for FOODiQ Global and is a fat woman. She is/has been a member of committees/working groups related to nutrition or food, including for the Australian Academy of Science, the NHMRC and the Nutrition Society of Australia; Jonathan Karnon does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment; Nial Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is a fellow of the Royal Australian Chemical Institute, a member of the Australasian Pharmaceutical Science Association and a member of the Australian Institute of Company Directors. Nial is the chief scientific officer of Vaihea Skincare LLC, a director of SetDose Pty Ltd (a medical device company) and a Standards Australia panel member for sunscreen agents. Nial regularly consults to industry on issues to do with medicine risk assessments, manufacturing, design and testing; Priya Sumithran has received grant funding from external organisations, including the NHMRC and MRFF. She is in the leadership group of the Obesity Collective and co-authored manuscripts with a medical writer provided by Novo Nordisk and Eli Lilly.

Fron Jackson-Webb, Deputy Editor and Senior Health Editor, The Conversation

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Opioids are commonly prescribed when you’re discharged from hospital after surgery to help manage pain at home.

These strong painkillers may have unwanted side effects or harms, such as constipation, drowsiness or the risk of dependence.

However, there are steps you can take to minimise those harms and use opioids more safely as you recover from surgery.

Which types of opioids are most common?

The most commonly prescribed opioids after surgery in Australia are oxycodone (brand names include Endone, OxyNorm) and tapentadol (Palexia).

In fact, about half of new oxycodone prescriptions in Australia occur after a recent hospital visit.

Most commonly, people will be given immediate-release opioids for their pain. These are quick-acting and are used to manage short-term pain.

Because they work quickly, their dose can be easily adjusted to manage current pain levels. Your doctor will provide instructions on how to adjust the dosage based on your pain levels.

Then there are slow-release opioids, which are specially formulated to slowly release the dose over about half to a full day. These may have “sustained-release”, “controlled-release” or “extended-release” on the box.

Slow-release formulations are primarily used for chronic or long-term pain. The slow-release form means the medicine does not have to be taken as often. However, it takes longer to have an effect compared with immediate-release, so it is not commonly used after surgery.

Controlling your pain after surgery is important. This allows you get up and start moving sooner, and recover faster. Moving around sooner after surgery prevents muscle wasting and harms associated with immobility, such as bed sores and blood clots.

Everyone’s pain levels and needs for pain medicines are different. Pain levels also decrease as your surgical wound heals, so you may need to take less of your medicine as you recover.

But there are also risks

As mentioned above, side effects of opioids include constipation and feeling drowsy or nauseous. The drowsiness can also make you more likely to fall over.

Opioids prescribed to manage pain at home after surgery are usually prescribed for short-term use.

But up to one in ten Australians still take them up to four months after surgery. One study found people didn’t know how to safely stop taking opioids.

Such long-term opioid use may lead to dependence and overdose. It can also reduce the medicine’s effectiveness. That’s because your body becomes used to the opioid and needs more of it to have the same effect.

Dependency and side effects are also more common with slow-release opioids than immediate-release opioids. This is because people are usually on slow-release opioids for longer.

Then there are concerns about “leftover” opioids. One study found 40% of participants were prescribed more than twice the amount they needed.

This results in unused opioids at home, which can be dangerous to the person and their family. Storing leftover opioids at home increases the risk of taking too much, sharing with others inappropriately, and using without doctor supervision.

How to mimimise the risks

Before using opioids, speak to your doctor or pharmacist about using over-the-counter pain medicines such as paracetamol or anti-inflammatories such as ibuprofen (for example, Nurofen, Brufen) or diclofenac (for example, Voltaren, Fenac).

These can be quite effective at controlling pain and will lessen your need for opioids. They can often be used instead of opioids, but in some cases a combination of both is needed.

Other techniques to manage pain include physiotherapy, exercise, heat packs or ice packs. Speak to your doctor or pharmacist to discuss which techniques would benefit you the most.

However, if you do need opioids, there are some ways to make sure you use them safely and effectively:

• ask for immediate-release rather than slow-release opioids to lower your risk of side effects
• do not drink alcohol or take sleeping tablets while on opioids. This can increase any drowsiness, and lead to reduced alertness and slower breathing
• as you may be at higher risk of falls, remove trip hazards from your home and make sure you can safely get up off the sofa or bed and to the bathroom or kitchen
• before starting opioids, have a plan in place with your doctor or pharmacist about how and when to stop taking them. Opioids after surgery are ideally taken at the lowest possible dose for the shortest length of time.

If you’re concerned about side effects

If you are concerned about side effects while taking opioids, speak to your pharmacist or doctor. Side effects include:

• constipation – your pharmacist will be able to give you lifestyle advice and recommend laxatives
• drowsiness – do not drive or operate heavy machinery. If you’re trying to stay awake during the day, but keep falling asleep, your dose may be too high and you should contact your doctor
• weakness and slowed breathing – this may be a sign of a more serious side effect such as respiratory depression which requires medical attention. Contact your doctor immediately.

If you’re having trouble stopping opioids

Talk to your doctor or pharmacist if you’re having trouble stopping opioids. They can give you alternatives to manage the pain and provide advice on gradually lowering your dose.

You may experience withdrawal effects, such as agitation, anxiety and insomnia, but your doctor and pharmacist can help you manage these.

How about leftover opioids?

After you have finished using opioids, take any leftovers to your local pharmacy to dispose of them safely, free of charge.

Do not share opioids with others and keep them away from others in the house who do not need them, as opioids can cause unintended harms if not used under the supervision of a medical professional. This could include accidental ingestion by children.

For more information, speak to your pharmacist or doctor. Choosing Wisely Australia also has free online information about managing pain and opioid medicines.

Katelyn Jauregui, PhD Candidate and Clinical Pharmacist, School of Pharmacy, Faculty of Medicine and Health, University of Sydney; Asad Patanwala, Professor, Sydney School of Pharmacy, University of Sydney; Jonathan Penm, Senior lecturer, School of Pharmacy, University of Sydney, and Shania Liu, Postdoctoral Research Fellow, Faculty of Medicine and Dentistry, University of Alberta

This article is republished from The Conversation under a Creative Commons license. Read the original article.