Caitie is a young doctor and is quick to admit that she overprescribes painkillers to her patients.

Sometimes it’s because the 25-year-old is being bullied by older patients complaining of their intense pain after surgery, other times it’s because there is a lack of beds in the hospital where she works and patients need to be discharged.

“I would feel safe with what I’m prescribing but sometimes I’m thinking they may not need opioids but to get them out of hospital quicker, I give it to them.”

Caitie works at a hospital in Melbourne and says young doctors overprescribing pain relief medication happens all too often.

“I think it’s trying to get people well enough to get out of hospital quicker with a strong pain relief,” she says. “There is a large pressure on us to get them out of the hospital and there’s institutional pressures from the nursing staff who need beds.

Some patients also became aggressive when she doesn’t prescribe them stronger pain killers. One patient had recently complained to the doctor on night shift that they needed opioids and the doctor had given it to them, despite Caitie refusing to prescribe it during the previous day.

Opioids are so strong, I don’t think people realise that.”

Caitie is not alone in her overprescribing.

Study finds junior doctors are over-prescribing

A new study from St Vincent's Hospital has shown junior doctors have been overprescribing powerful painkillers like opioids without proper guidance from their seniors.

The report looked at the number of painkillers being prescribed by junior doctors over a seven year period in the Sydney hospital and found more than a quarter of them (27%) were inappropriate.

Dr Jennifer Stevens, who is an anaesthetist and ran the study, said the hospital had failed to adequately prepare their junior doctors on prescription medications, particularly after patients came out of surgery and were about to go home.

“The problem is that up until about three years ago we didn't realise that if you start somebody on a particular type of medication, they are much more likely to continue that medication in the long term,” Dr Stevens said.

The hospital, which is one of the largest in Sydney, had noticed the use of the drug oxycodone had almost increased by 300 per cent in a seven year period. In 2015, oxycodone tablets prescribed to patients being discharged from the hospital was 12,000, increasing to 31,000 in 2012.

Another junior doctor, Andrew, who is 28 and based in Melbourne, said if he does prescribe the painkillers it will only be of his superior has suggested it.

“I would never prescribe an opioid unless they had taken it in hospital,” he said.

“We do often prescribe them but only to get through the next few days, then they should go to their GP with what we have given them.”

Bernadette, 30, who works in a hospital in Southern NSW, said she had received formal education on opioid use and wished other junior doctors could get the same training.

“I have received comprehensive education in patients who are high risk,” she told Hack. “It was fantastic education and I use it every day. We were taught about how to look for information and advice to look at opioid use and misuse.”

“I feel like I have been equipped with the skills and I know how to ask for help and refer when I feel like I need to,” she said.

Opioid use in Australia

Addiction to powerful painkillers like opioids is one of the most pressing public health issues in Australia.

The latest figures from 2014 show that 800 people are dying a year from prescription drug overdoses.

One in four people who are prescribed opioids become addicted, according to the International Association for the Study of Pain.

In the United States, the story is a lot worse. About 150 people are dying a day from opioid overdoses, prompting US President Donald Trump to announce the use of opioids was a “national emergency" last week.

What's the solution?

Dr Stevens said when junior doctors were shown the number of painkillers they were prescribing compared with doctors from three to five years ago, they dramatically altered their behaviour.

She said in one year the percentage of inappropriate opioids being prescribed decreased by 60 per cent, from 26 per cent to 10 per cent.

“We discovered that the way to change our prescribing at discharging was to focus on that group of doctors by educating them better and to provide individual feedback on their prescribing practices” Dr Stevens said.

She said patients were also leaving hospital earlier after their operations, often with packets of painkillers but with no support in how to use them.

“We should only give patients a limited supply and then tell them to go to the GP in the post surgery stage,” she said.

“This is the message for the junior doctors - that I don't think they have been given enough education on pain management because there is not a lot that happens in medical schools at the moment.”

“The message to other hospitals was that generalised education wasn’t working, you had to sit the doctors down and show their personalised prescribing practices.”

“We have to audit ourselves,” she said. “As pain specialists we have to take more responsibility for our junior doctors.”