Bay of Plenty District Health Board has defended its use of strong opioids after a commission found it had the third highest prescription rate in the country.
A Health Quality and Safety Commission analysis revealed Wairarapa had the nation's highest prescription rate, followed by Nelson-Marlborough and Bay of Plenty.
The commission is calling on district health boards to examine their use of strong painkillers as the prescription rates were much higher in some areas than others.
The figures were included in the commission's Atlas of Healthcare Variation, a new database of health services and outcomes. The doses have been dispensed from community pharmacies in 2013, and did not include drugs given in hospitals. However, nearly half of those given the strong opioids had been treated at a public hospital in the week before.
Strong opioids include methadone, morphine, fentanyl and oxycodone. Commonly used weak opioids include codeine, tramadol and dihydrocodeine.
Bay of Plenty DHB spokeswoman Sandra Fielding said opioid medication was highly effective for acute, severe pain. In the majority of cases, it was an effective and safe short-term treatment, she said.
"The majority of the opioid prescribing within the hospital and Emergency Department setting relates to acute injury or surgery and is appropriate use of strong analgesia. Opioids are also used within palliative care or for some people with ongoing chronic injuries."
Ms Fielding, the DHB's Safe Use of High Risk Medication project leader, said alternatives were reviewed regularly.
"There are risks associated with prolonged use of opioid medication and doctors both within the hospital and general practice regularly review, trial and discuss with patients other alternatives for the management of longer term or chronic pain.
"Other medications such as non-steroidal anti-inflammatories, Paracetamol and therapies such as Transcutaneous Nerve Stimulation are just some of the alternatives which may be used to reduce the amount or duration of opioid medication use."
Efforts were also being made to reduce the opioid medication use in the long term, she said.
"The Bay of Plenty District Health Board has a clinical pain service which includes a team of medical, nursing and Allied Health staff, who provide review, advice and support for patients who have a chronic or complex pain syndrome."
Dr Alan Davis, chairman of the commission's expert advisory group, said opioids were effective in managing pain but were also the class of medicine most often implicated in patient harm - including addiction or oversedation.
"The question is, do we need to use strong opioids as much as we do?" Dr Davis said.
The lowest rates of strong opioid use were in Capital and Coast, Auckland and Canterbury. The commission also found women were dispensed significantly more strong and weak opioid drugs.
Use increased with age, and people of European ethnicity had two to four times higher use of strong opioids than Maori, Pacific or Asian people.