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Isoardi KZ, Isbister GK. Opioid poisoning in Newcastle over the last three decades: From heroin to prescription opioids. Emerg Med Australas 2023; 35:946-952. [PMID: 37415078 PMCID: PMC10947284 DOI: 10.1111/1742-6723.14272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE Opioid-related harm has risen in recent decades, but limited research describes the clinical burden of opioid poisoning to Australian EDs. We aimed to investigate hospital presentations with opioid poisoning over three decades. METHODS This is an observational series of prospectively collected data investigating presentations of opioid poisoning to an ED in Newcastle (1990-2021). Type of opioid, naloxone administration, intubation, intensive care unit (ICU) admission, length of stay and death were extracted from the unit's database. RESULTS There were 4492 presentations in 3574 patients (median age 36, 57.7% female), increasing from an average of 93 presentations annually in the first decade to 199 in the third decade. Deliberate self-poisonings accounted for 3694 presentations (82.2%). Heroin dominated the 1990s, peaking in 1999 before decreasing. Prescription opioids then rose, with codeine (usually in paracetamol combination) predominating until 2018, after which oxycodone presentations exceeded them. Methadone consistently increased from six presentations annually in the first decade to 16 in the last decade. Naloxone was administered in 990 (22.0%) presentations and 266 (5.9%) were intubated, most frequently following methadone and heroin exposures. ICU admissions increased from 5% in 1990 to 16% in 2021. Codeine exposures resulted in less severe effects, whereas methadone had more severe effects overall. The median length of stay was 17 h (interquartile range 9-27 h). There were 28 deaths (0.6%). CONCLUSION Opioid presentations increased in number and severity over three decades as the type of opioid changed. Oxycodone is currently the main opioid of concern. Methadone poisoning was the most severe.
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Affiliation(s)
- Katherine Z Isoardi
- Clinical Toxicology Research GroupThe University of NewcastleNewcastleNew South WalesAustralia
| | - Geoffrey K Isbister
- Clinical Toxicology Research GroupThe University of NewcastleNewcastleNew South WalesAustralia
- Department of Clinical ToxicologyCalvary Mater NewcastleNewcastleNew South WalesAustralia
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2
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Moffat AK, Apajee J, Le Blanc VT, Westaway K, Andrade AQ, Ramsay EN, Blacker N, Pratt NL, Roughead EE. Reducing opioid use for chronic non-cancer pain in primary care using an evidence-based, theory-informed, multistrategic, multistakeholder approach: a single-arm time series with segmented regression. BMJ Qual Saf 2023; 32:623-631. [PMID: 37105724 PMCID: PMC10646855 DOI: 10.1136/bmjqs-2022-015716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/12/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Many countries have high opioid use among people with chronic non-cancer pain. Knowledge about effective interventions that could be implemented at scale is limited. We designed a national intervention that included audit and feedback, deprescribing guidance, information on catastrophising assessment, pain neuroscience education and a cognitive tool for use by patients with their healthcare providers. METHOD We used a single-arm time series with segmented regression to assess rates of people using opioids before (January 2015 to September 2017), at the time of (October 2017) and after the intervention (November 2017 to August 2019). We used a cohort with historical comparison group and log binomial regression to examine the rate of psychologist claims in opioid users not using psychologist services prior to the intervention. RESULTS 13 968 patients using opioids, 8568 general practitioners, 8370 pharmacies and accredited pharmacists and 689 psychologists were targeted. The estimated difference in opioid use was -0.51 persons per 1000 persons per month (95% CI -0.69, -0.34; p<0.001) as a result of the intervention, equating to 25 387 (95% CI 24 676, 26 131) patient-months of opioid use avoided during the 22-month follow-up. The targeted group had a significantly higher rate of incident patient psychologist claims compared with the historical comparison group (rate ratio: 1.37, 95% CI 1.16, 1.63; p<0.001), equating to an additional 690 (95% CI 289, 1167) patient-months of psychologist treatment during the 22-month follow-up. CONCLUSIONS Our intervention addressed the cognitive, affective and sensory factors that contribute to pain and consequent opioid use, demonstrating it could be implemented at scale and was associated with a reduction in opioid use and increasing utilisation of psychologist services.
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Affiliation(s)
- Anna K Moffat
- Clinical and Health Sciences, University of South Australia, Adelaide, 5000, South Australia, Australia
| | - Jemisha Apajee
- Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vanessa T Le Blanc
- Clinical and Health Sciences, University of South Australia, Adelaide, 5000, South Australia, Australia
| | - Kerrie Westaway
- Clinical and Health Sciences, University of South Australia, Adelaide, 5000, South Australia, Australia
| | - Andre Q Andrade
- Clinical and Health Sciences, University of South Australia, Adelaide, 5000, South Australia, Australia
| | - Emmae N Ramsay
- Clinical and Health Sciences, University of South Australia, Adelaide, 5000, South Australia, Australia
| | - Natalie Blacker
- Clinical and Health Sciences, University of South Australia, Adelaide, 5000, South Australia, Australia
| | - Nicole L Pratt
- Clinical and Health Sciences, University of South Australia, Adelaide, 5000, South Australia, Australia
| | - Elizabeth Ellen Roughead
- Clinical and Health Sciences, University of South Australia, Adelaide, 5000, South Australia, Australia
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Mitra B, Roman C, Wu B, Luckhoff C, Goubrial D, Amos T, Bannon-Murphy H, Huynh R, Dooley M, Smit DV, Cameron PA. Restriction of oxycodone in the emergency department (ROXY-ED): A randomised controlled trial. Br J Pain 2023; 17:491-500. [PMID: 38107754 PMCID: PMC10722107 DOI: 10.1177/20494637231189031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Background The prescription of opioids in emergency care has been associated with harm, including overdose and dependence. The aim of this trial was to assess restriction of access to oxycodone (ROXY), in combination with education and guideline modifications, versus education and guideline modifications alone (standard care) to reduce oxycodone administration in the Emergency Department (ED). Methods An unblinded, active control, randomised controlled trial was conducted in an adult tertiary ED. Participants were patients aged 18-75 years who had analgesics administered in the ED. The primary intervention was ROXY, through removal of all oxycodone immediate release tablets from the ED imprest, with availability of a small supply after senior clinician approval. The intervention did not restrict prescription of discharge medications. The primary outcome measure was oxycodone administration rates. Secondary outcomes were administration rates of other analgesic medications, time to initial analgesics and oxycodone prescription on discharge. Results There were 2258 patients eligible for analysis. Oxycodone was administered to 80 (6.1%) patients in the ROXY group and 221 (23.3%) patients in the standard care group (relative risk (RR) 0.26; 95% CI: 0.21 to 0.33; p < .001). Tapentadol was prescribed more frequently in the ROXY group (RR 2.17; 95% CI: 1.71-2.74), while there were no differences in prescription of other analgesic medications. On discharge, significantly fewer patients were prescribed oxycodone (RR 0.51; 95% CI: 0.39-0.66) and no differences were observed in prescription rates of other analgesic medications. There was no difference in time to first analgesic (HR 0.94; 95% CI: 0.86-1.02). Conclusions Restricted access to oxycodone was superior to education and guideline modifications alone for reducing oxycodone use in the ED and reducing discharge prescriptions of oxycodone from the ED. The addition of simple restrictive interventions is recommended to enable rapid changes to clinician behaviour to reduce the potential harm associated with the prescribing of oxycodone in the ED.
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Affiliation(s)
- Biswadev Mitra
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Cristina Roman
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
- Pharmacy Department, Alfred Health, Melbourne, VIC, Australia
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
| | - Bertha Wu
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | - Carl Luckhoff
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | - Diana Goubrial
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
- Pharmacy Department, Alfred Health, Melbourne, VIC, Australia
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
| | - Timothy Amos
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | | | - Ronald Huynh
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
| | - Michael Dooley
- Pharmacy Department, Alfred Health, Melbourne, VIC, Australia
- Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
| | - De Villiers Smit
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Peter A. Cameron
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia
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4
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Menahem S, Freud T, Batat E, Shvartzman P. Opioid consumption by cancer patients in an Israeli Health Maintenance Organization from 2007-2018. Support Care Cancer 2023; 31:560. [PMID: 37668801 DOI: 10.1007/s00520-023-08027-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 08/28/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE Opioids are the cornerstone of therapy for cancer patients with moderate to severe pain. The objective was to characterize opioid purchases by cancer patients in Clalit Health Services (CHS), the largest Health Maintenance Organization in Israel, over the years 2007-2018. METHODS Data for all CHS cancer patients aged 18 years old and above who purchased an opioid at least once during the 12-year study period were obtained from computerized databases. The amount of opioids was converted into oral morphine equivalents (OME). RESULTS 108,543 cancer patients who purchased opioids at least once were enrolled. They comprised 30.5% of the CHS purchasers of opioids in the study period. The total number of cancer patients who purchased an opioid at least once increased gradually from 13,057 in 2007 to 20,675 (58% increase) in 2018, while the annual number of CHS cancer patients increased by only 39%. The annual OME per capita increased from 753 mg in 2007 to 1,432 mg in 2018 (91% increase). In 2007 8.1% of the cancer patients purchased opioids and 9.2% in 2018. Two thirds of all cancer patients purchased opioids for three months or less, 11.9% continued for more than one year, and 5.8% for more than two years. CONCLUSIONS There is a clinically non-significant increase in the rate of cancer patients purchasing opioids. About two thirds of the cancer patients purchased opioids for only three months, and 94% for up to two years. Under-treatment of cancer pain should still be of concern. While patients are prescribed higher doses, under-prescription may still be a problem..
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Affiliation(s)
- Sasson Menahem
- Pain and Palliative Care Unit, Kappy and Eric Flanders National Palliative Care Resource Center, The Haim Doron Division of Community Health,Faculty of Health Sciences, Ben-Gurion University of the Negev, PO BOX 653, Beer-Sheva, Israel
- Siaal Research Center for Family Medicine and Primary Care, Department of Family Medicine, The Haim Doron Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Community Division, Clalit Health Services, Southern District, Beer-Sheva, Israel
| | - Tamar Freud
- Siaal Research Center for Family Medicine and Primary Care, Department of Family Medicine, The Haim Doron Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Erez Batat
- Health Planning and Policy Wing, Clalit Health Services, Community Division, Tel-Aviv, Israel
| | - Pesach Shvartzman
- Pain and Palliative Care Unit, Kappy and Eric Flanders National Palliative Care Resource Center, The Haim Doron Division of Community Health,Faculty of Health Sciences, Ben-Gurion University of the Negev, PO BOX 653, Beer-Sheva, Israel.
- Siaal Research Center for Family Medicine and Primary Care, Department of Family Medicine, The Haim Doron Division of Community Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
- Community Division, Clalit Health Services, Southern District, Beer-Sheva, Israel.
- Pain and Palliative Care Unit, Soroka University Medical Center, Beer-Sheva, Israel.
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5
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Fong ISH, Yiu CH, Abelev MD, Allaf S, Begley DA, Bugeja BA, Khor KE, Rimington J, Penm J. Supply of opioids and information provided to patients after surgery in an Australian hospital: A cross-sectional study. Anaesth Intensive Care 2023; 51:340-347. [PMID: 37688434 PMCID: PMC10493037 DOI: 10.1177/0310057x231163890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Opioids are commonly prescribed to manage pain after surgery. However, excessive supply on discharge can increase patients' risk of persistent opioid use and contribute to the reservoir of unused opioids in the community that may be misused. This study aimed to evaluate the use of opioids in Australian surgical patients after discharge and patient satisfaction with the provision of opioid information after discharge. This prospective cohort study was conducted at a tertiary referral and teaching hospital. Surgical patients were called 7-28 days after discharge to identify their opioid use and the information that they received after discharge. In total, 66 patients responded. Most patients underwent orthopaedic surgery (45.5%; 30/66). The median days of opioids supplied on discharge was 5 (IQR 3-5). In total, 40.9% (27/66) of patients had >50% of their opioids remaining. Patients undergoing orthopaedic surgery were less likely to have >50% of their opioids remaining (P = 0.045), whilst patients undergoing urological or renal surgeries were significantly more likely (P = 0.009). Most patients recalled receiving information about their opioids (89.4%; 59/66). However, the majority (51.5%; 34/66) did not recall receiving any information about the signs of opioid toxicity and interactions between opioids and alcohol. In conclusion, around 40% of patients had more than half of their opioid supply remaining after they ceased taking their opioid. Although most patients recalled receiving information about their opioids, more than half did not recall receiving any information about the signs of opioid toxicity or interactions between opioids and alcohol.
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Affiliation(s)
- Ian SH Fong
- Department of Pharmacy, Prince of Wales Hospital, Randwick, Australia
| | - Chin Hang Yiu
- School of Pharmacy, The University of Sydney Faculty of Medicine and Health, Camperdown, Australia
| | - Matthew D Abelev
- School of Pharmacy, The University of Sydney Faculty of Medicine and Health, Camperdown, Australia
| | - Sara Allaf
- School of Pharmacy, The University of Sydney Faculty of Medicine and Health, Camperdown, Australia
| | - David A Begley
- Department of Pain Management. Prince of Wales Hospital, Randwick, Australia
| | - Bernadette A Bugeja
- Department of Pain Management. Prince of Wales Hospital, Randwick, Australia
| | - Kok Eng Khor
- Department of Pain Management. Prince of Wales Hospital, Randwick, Australia
| | - Joanne Rimington
- District Pharmacy Services, South Eastern Sydney Local Health District, Randwick, Australia
| | - Jonathan Penm
- Department of Pharmacy, Prince of Wales Hospital, Randwick, Australia
- School of Pharmacy, The University of Sydney Faculty of Medicine and Health, Camperdown, Australia
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6
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Darke S, Farrell M, Lappin J. Overdose and suicide are different phenomena among opioid users that require different clinical management. Aust N Z J Psychiatry 2023:48674231159298. [PMID: 36872821 DOI: 10.1177/00048674231159298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Given the high rates of mental health comorbidity among opioid users, and increasing rates of opioid prescription for chronic pain, psychiatrists and mental health clinicians are likely to treat patients who are dependent on opioids. Among such patients, many will have histories of opioid overdose or suicide attempts. It is tempting to assume that these are related behaviours and that 'accidental' overdoses are actually suicide attempts. We provide evidence here to demonstrate that while some overdoses are intentional, most are not. More than half of deaths among opioid users are due to unintentional overdose. Suicides constitute a minority: less than 10% of heroin user deaths are estimated to be due to suicide, as are 20-30% of prescribed opioid fatalities. Moreover, suicide attempts are more commonly made using means other than opioids. Overdose and suicide among opioid dependent patients are two distinct phenomena, associated with different risk factors, that need to be separately assessed and their respective risk managed.
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Affiliation(s)
- Shane Darke
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Michael Farrell
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Julia Lappin
- National Drug & Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.,School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
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Chaw SH, Lo YL, Yeap LL, Haron DEBM, Shariffuddin II. Population Pharmacokinetics and Dosing Simulations of Intravenous Oxycodone for Perioperative Pain Relief in Adult Surgical Patients with Obesity. Eur J Drug Metab Pharmacokinet 2023; 48:11-21. [PMID: 36207565 DOI: 10.1007/s13318-022-00795-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Oxycodone, a semisynthetic thebaine derivative µ-opioid (MOP) receptor agonist, is effective for treating moderate and severe pain in different clinical conditions. The pharmacokinetics of intravenous oxycodone in the obese population has not been studied. This study aims to characterize the pharmacokinetic profile of oxycodone after intravenous administration and to simulate an appropriate dosage for analgesic efficacy in obese patients. METHODS We recruited 33 (age range from 21 to 72 years) adult patients with a body mass index of 30 kg/m2 and above, who were scheduled for non-cardiac surgeries. Intravenous oxycodone was administered after induction of general anesthesia and blood samples were collected up to 24 h after oxycodone administration. Plasma concentrations of oxycodone were assayed using liquid chromatography-tandem mass spectrometry and 253 concentration-time points were used for pharmacokinetic analysis using nonlinear mixed-effects modeling. RESULTS Intravenous oxycodone pharmacokinetics were well described by a two-compartment open model. The estimated total clearance and central volume of distribution of oxycodone are 28.5 l/h per 70 kg and 56.4 l per 70 kg, respectively. Total body weight was identified as a significant covariate of the clearance and central volume of distribution. Dosing simulations based on the final model demonstrate that a starting dose of 0.10 mg/kg of intravenous oxycodone is adequate to achieve a target plasma concentration and repeated doses of 0.02 mg/kg may be administered at 1.5-h intervals to maintain a plasma concentration within an effective analgesic range. CONCLUSIONS A population pharmacokinetic model using total body weight as a covariate supports the administration of 0.10 mg/kg of intravenous oxycodone as a starting dose and repeated doses of 0.02 mg/kg at 1.5-h intervals to maintain targeted plasma concentrations for analgesia in the obese adult population.
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Affiliation(s)
- Sook Hui Chaw
- Department of Anaesthesiology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Yoke Lin Lo
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, No. 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia.
| | - Li Ling Yeap
- Universiti Malaya Specialist Centre, Lembah Pantai, 50603, Kuala Lumpur, Malaysia.,School of Pharmacy, Monash University Malaysia, 47500 Subang Jaya, Selangor, Malaysia
| | - Didi Erwandi Bin Mohamad Haron
- The Institute of Research Management and Services, Deputy Vice-Chancellor (Research and Innovation), Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Ina Ismiarti Shariffuddin
- Department of Anaesthesiology, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
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Reward drive moderates the effect of depression-related cognitive mechanisms on risk of prescription opioid misuse among patients with chronic non-cancer pain. THE JOURNAL OF PAIN 2022; 24:655-666. [PMID: 36442816 DOI: 10.1016/j.jpain.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/13/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
Depression, a prognostic factor for prescription opioid misuse commonly occurs in people with chronic non-cancer pain (CNCP). However, the mechanisms linking depression and prescription opioid misuse remain unclear. This study examined the potential mediating role of pain catastrophizing in the association between depressive symptoms and prescription opioid misuse risk, and impulsivity traits as possible moderators of these relationships. Individuals (N = 198; 77% women) with CNCP using prescription opioids participated in a cross-sectional online survey with validated measures of depression, pain catastrophizing, rash impulsiveness, reward drive, anxiety, pain severity and prescription opioid misuse. Meditation analyses with percentile-based bootstrapping examined pathways to prescription opioid use, controlling for age, sex, pain severity, and anxiety symptoms. Partial moderated mediation of the indirect effect of depressive symptoms on prescription opioid misuse risk through pain catastrophizing by rash impulsiveness and reward drive were estimated. Pain catastrophizing mediated depressive symptoms and prescription opioid misuse risk. Indirect effects were stronger when moderate to high levels of reward drive were included in the model. Findings suggest the risk of prescription opioid misuse in those experiencing depressive symptoms and pain catastrophizing is particularly higher for those higher in reward drive. Treatments targeting these mechanisms may reduce opioid misuse risk. PERSPECTIVE: This article identifies reward drive as a potentially important factor increasing the effects of depression-related cognitive mechanisms on risk of prescription opioid misuse in those with CNCP. These findings could assist in personalizing clinical CNCP management to reduce the risks associated with opioid misuse.
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9
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Raza SA, Keith MB, Koh KC. Perspectives on Using Fast-Dissolving Paracetamol for Mild-to-Moderate Pain Management in Elderly or Diabetic Patients with Delayed Gastric Emptying Rates: An Exploratory Study. J Pain Res 2022; 15:3675-3688. [DOI: 10.2147/jpr.s373666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/28/2022] [Indexed: 12/03/2022] Open
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10
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Takahashi R, Miyashita M, Murakami Y, Oba MS. Trends in strong opioid prescription for cancer patients in Japan from 2010 to 2019: an analysis with large medical claims data. Jpn J Clin Oncol 2022; 52:1297-1302. [PMID: 35907780 DOI: 10.1093/jjco/hyac122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/14/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Consumption of opioids, essential drugs for pain relief, has seen rapid growth worldwide. In Japan, where total opioid consumption still remains low among developed countries, little is known about trends in the clinical patterns of opioids in terminally ill cancer patients. METHODS Patients who died of cancer from 2010 to 2019 were included in this study. Morphine, oxycodone, fentanyl, tapentadol, methadone and hydromorphone were examined as opioids for cancer pain. We calculated the prevalence of prescribed opioids prior to death by year and age group and the average opioid dose 30 days before death. RESULTS The total number of patients was 221 598. We found that the prescription prevalence of opioids increased from 60.8 to 65.9% (5.1%). Morphine was most prescribed in 2010 but had decreased prevalence (-9.0%) during the 10-year period. Oxycodone had the highest increase in prescription prevalence (13.7%), and fentanyl prevalence decreased (-4.9%). In the subgroup comparison, the prescription prevalence of opioids in the elderly was lower than that in the younger group; however, the increasing trend in the elderly was greater than that in the younger group. The percentage of patients prescribed low-dose opioids (<60 mg/day) during the 30 days before death increased by 4.9% and was the highest throughout the study period. CONCLUSION The prevalence of opioid prescriptions for terminally ill cancer patients has increased from 2010 to 2019 in Japan. The opioid-specific trends were similar to the global trend but differed by palliative care specialty.
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Affiliation(s)
- Richi Takahashi
- Department of Medical Statistics, Toho University Graduate School of Medicine, Tokyo, Japan.,Yokohama Cancer Chemotherapy & Palliative Care Support Division, Toda Medical Care Group, Kanagawa, Japan.,Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Yoshitaka Murakami
- Department of Medical Statistics, Faculty of Medicine, Toda Medical Care Group, Toho University, Tokyo, Japan
| | - Mari S Oba
- Department of Clinical Data Science, Clinical Research & Education Promotion Division, National Center of Neurology and Psychiatry, Tokyo, Japan
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11
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Tran T, Ford J, Hardidge A, Antoine S, Veevers B, Taylor S, Elliott RA. Evaluation of a post-discharge pharmacist opioid review following total knee arthroplasty: a pre- and post-intervention cohort study. Int J Clin Pharm 2022; 44:1269-1276. [PMID: 35829822 PMCID: PMC9277971 DOI: 10.1007/s11096-022-01455-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/25/2022] [Indexed: 11/26/2022]
Abstract
Background More than 70% of patients continue to use opioid medications 3-weeks following total knee arthroplasty. Post-discharge pharmacist reviews improve medication management, however it’s effect on opioid usage is not known. Aim This study aimed to evaluate the impact of post-discharge pharmacist review on opioid use following a total knee arthroplasty. Method A pilot, cohort pre- and post-intervention study was undertaken on patients who had undergone a total knee arthroplasty and were supplied an opioid upon discharge from hospital. During the intervention, patients were contacted via telephone by a pharmacist approximately five days post-discharge to review analgesic usage, provide education and advice and communicate an opioid management plan to their general practitioner. The primary endpoint was the percentage of patients taking opioids 3-weeks post-discharge. Secondary endpoints included: percentage of patients obtaining an opioid refill; patient satisfaction with opioid supply and the pharmacist review. Results Pre- and post-intervention, 63 and 44 patients were included, respectively. The percentage of patients taking opioids 3-weeks post-discharge declined from 74.6 to 29.6% (p < 0.001) and the percentage requiring an opioid refill from their general practitioner declined from 71.4 to 36.4% (p < 0.001). More patients were satisfied with opioid supply during the intervention period (79.5% cf. 47.6%, p = 0.001). Twenty-eight (63.6%) patients could recall the post-discharge pharmacist review, and all were either satisfied or extremely satisfied with the review. Conclusion Pharmacist-delivered post-discharge analgesia review reduced the percentage of patients taking opioids 3-weeks post-discharge following a total knee arthroplasty. This intervention has the potential to provide a smoother transition of care for patients supplied with opioids at the time of hospital discharge.
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Affiliation(s)
- Tim Tran
- Pharmacy Department, Austin Health, Heidelberg, VIC, Australia.
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia.
| | - James Ford
- Pharmacy Department, Austin Health, Heidelberg, VIC, Australia
| | - Andrew Hardidge
- Orthopaedic Surgery, Austin Health, Heidelberg, VIC, Australia
| | - Shari Antoine
- Health Independence Program, Austin Health, Heidelberg, VIC, Australia
| | - Beth Veevers
- Health Independence Program, Austin Health, Heidelberg, VIC, Australia
| | - Simone Taylor
- Pharmacy Department, Austin Health, Heidelberg, VIC, Australia
| | - Rohan A Elliott
- Pharmacy Department, Austin Health, Heidelberg, VIC, Australia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
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12
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Suckling B, Pattullo C, Liu S, James P, Donovan P, Patanwala A, Penm J. Persistent opioid use after hospital discharge in Australia: a systematic review. AUST HEALTH REV 2022; 46:367-380. [PMID: 35545810 DOI: 10.1071/ah21353] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/17/2022] [Indexed: 11/23/2022]
Abstract
ObjectiveThis systematic review identified studies that provided an estimate of persistent opioid use following patient discharge from hospital settings in Australia.MethodsA literature search was performed on 5 December 2020, with no date restrictions to identify studies that reported a rate of persistent opioid use following patient discharge from Australian Hospitals. The search strategy combined all terms relating to the themes 'hospital patients', 'prescribing', 'opioids' and 'Australia'. Studies that dealt solely with cancer, palliative care or addiction medicine were excluded. The databases searched in this review were Embase, PubMed, Scopus, CINAHL, and International Pharmaceutical Abstracts. Studies were assessed for bias using the Newcastle-Ottawa Scale and considered against international literature.ResultsIn total, 13 publications are included for final analysis in this review. Of these, 11 articles relate to post-surgical opioid use. With one exception, studies were of a 'good' quality. Methods of data collection in included studies were a mixture of those conducting follow up of patients directly over time and those utilising dispensing databases. Persistent opioid use among surgical patients generally ranged from 3.9 to 10.5% at between 2 and 4 months after discharge.ConclusionsHow rates of persistent opioid use following hospital encounters in Australia are established, and how long after discharge rates are reported, is heterogeneous. Literature primarily relates to post-surgical patients, with very few studies investigating other settings such as encounters with the emergency department.
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Affiliation(s)
- Benita Suckling
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia; and Caboolture Hospital Pharmacy Department, Metro North Health, Queensland Health, Caboolture, Qld, Australia
| | - Champika Pattullo
- Clinical Pharmacology Department, Royal Brisbane and Women's Hospital, Queensland Health, Herston, Qld, Australia
| | - Shania Liu
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia; and Department of Pharmacy, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Prudence James
- Redcliffe Hospital Pharmacy Department, Queensland Health, Redcliffe, Qld, Australia
| | - Peter Donovan
- Clinical Pharmacology Department, Royal Brisbane and Women's Hospital, Queensland Health, Herston, Qld, Australia
| | - Asad Patanwala
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia; and Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Jonathan Penm
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia; and Department of Pharmacy, Prince of Wales Hospital, Randwick, NSW, Australia
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Hudson MAJ, Koizia LJ, Fertleman MB. We Must Consider a Growing Opioid Epidemic in Older People. Geriatr Orthop Surg Rehabil 2022; 13:21514593221083823. [PMID: 35282298 PMCID: PMC8915207 DOI: 10.1177/21514593221083823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/03/2022] [Accepted: 02/09/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Murray A J Hudson
- Cutrale Perioperative and Ageing Group, Department of Bioengineering, Imperial College London, White City Campus, Sir Michael Uren Hub, 86 Wood Lane, London W12 0BZ, UK
| | - Louis J Koizia
- Cutrale Perioperative and Ageing Group, Department of Bioengineering, Imperial College London, White City Campus, Sir Michael Uren Hub, 86 Wood Lane, London W12 0BZ, UK
| | - Michael B Fertleman
- Cutrale Perioperative and Ageing Group, Department of Bioengineering, Imperial College London, White City Campus, Sir Michael Uren Hub, 86 Wood Lane, London W12 0BZ, UK
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Bennell KL, Bayram C, Harrison C, Brand C, Buchbinder R, Haas R, Hinman RS. Trends in management of hip and knee osteoarthritis in general practice in Australia over an 11-year window: a nationwide cross-sectional survey. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 12:100187. [PMID: 34527976 PMCID: PMC8356093 DOI: 10.1016/j.lanwpc.2021.100187] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/03/2021] [Accepted: 05/25/2021] [Indexed: 12/12/2022]
Abstract
Background We aimed to describe trends in knee and hip OA management by general medical practitioners (GPs) in Australia. Methods We analysed cross-sectional survey data from the Bettering the Evaluation and Care of Health (BEACH) program (1,000 randomly-selected GPs annually recording 100 consecutive patient encounters) over two periods: Period one April 1, 2005-March 31, 2010 and period two April 1, 2010-March 31, 2016. This included data from 10,738 GPs and 1,073,800 patient encounters with 6,565 GPs and 9,196 patient encounters for hip/knee OA. Data were summarized using descriptive statistics and 95% confidence intervals around point estimates. Findings Rate of knee OA problems managed by GPs increased in period two (7•1 (6•9-7•4) vs 6•2 (95% CI 6•0-6•5) per 1,000 all encounters), with a similar trend for hip OA. Encounter rates rose for some subgroups but remained stable for vulnerable subgroups. Although use of Medicare chronic disease management items, referral to allied health professionals and advice/education and lifestyle management (knee OA) increased, rates remained low. Use of MRI imaging rose. Overall medication rates were stable but substantially higher than non-pharmacological treatments. Declining reliance on non-steroidal anti-inflammatory drugs and glucosamine and increased reliance on paracetamol (knee OA) and opioids were demonstrated. Interpretation GPs in Australia are more frequently managing knee and hip OA. While small changes in GP management actions occured, rates of recommended first-line non-pharmacological treatments remained low and imaging, medications, and surgical referral rates high. Strategies are needed to optimise lifestyle management and reduce low-value care, with attention to healthcare disparities. Funding Funding was provided for this report by the National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Translational Research in Musculoskeletal Pain (#1079078).
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Affiliation(s)
- Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Clare Bayram
- Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Harrison
- Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Caroline Brand
- The University of Melbourne and The Royal Melbourne hospital, Parkville Victoria 3010, Australia and Department of Epidemiology and Preventive Medicine, School of public Health and Preventive Medicine, Monash University, Melbourne, 3004, Victoria, Australia
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 4 Drysdale St, Malvern, Victoria 3144, Australia
| | - Romi Haas
- Monash Department of Clinical Epidemiology, Cabrini Institute and Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 4 Drysdale St, Malvern, Victoria 3144, Australia
| | - Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Parkville, Victoria, 3010, Australia
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Bui T, Bortz H, Cairns KA, Graudins LV, Corallo CE, Konstantatos A, Tran H, Cheng A, Dooley MJ. AAA stewardship: managing high‐risk medications with dedicated antimicrobial, anticoagulation and analgesic stewardship programs. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2021. [DOI: 10.1002/jppr.1716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Thuy Bui
- Pharmacy Department Alfred Health Melbourne Australia
- Faculty of Pharmacy and Pharmaceutical Sciences Monash University Parkville Australia
| | - Hadley Bortz
- Pharmacy Department Alfred Health Melbourne Australia
- Faculty of Pharmacy and Pharmaceutical Sciences Monash University Parkville Australia
| | - Kelly A. Cairns
- Pharmacy Department Alfred Health Melbourne Australia
- Faculty of Pharmacy and Pharmaceutical Sciences Monash University Parkville Australia
| | | | - Carmela E. Corallo
- Pharmacy Department Alfred Health Melbourne Australia
- Faculty of Pharmacy and Pharmaceutical Sciences Monash University Parkville Australia
| | - Alex Konstantatos
- Anaesthesia and Perioperative Medicine Department Alfred Health Melbourne Australia
- Medicine, Nursing and Health Sciences Monash University Melbourne Australia
| | - Huyen Tran
- Haemostasis Thrombosis Unit Alfred Health Melbourne Australia
- The Australian Centre for Blood Disease Monash University Melbourne Australia
| | - Allen Cheng
- Infectious Diseases Unit Alfred Health Melbourne Australia
- School of Public Health and Preventive Medicine Monash University Melbourne Australia
| | - Michael J. Dooley
- Pharmacy Department Alfred Health Melbourne Australia
- Faculty of Pharmacy and Pharmaceutical Sciences Monash University Parkville Australia
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Donovan PJ, Arroyo D, Pattullo C, Bell A. Trends in opioid prescribing in Australia: a systematic review. AUST HEALTH REV 2021; 44:277-287. [PMID: 32241339 DOI: 10.1071/ah18245] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 04/15/2019] [Indexed: 12/25/2022]
Abstract
Objective This review systematically identified studies that estimated the prevalence of prescription opioid use in Australia, assessed the prevalence estimates for bias and identified areas for future research. Methods Literature published after 2000 containing a potentially representative estimate of prescription opioid use in adults, in the community setting, in Australia was included in this review. Studies that solely assessed opioid replacement, illicit opioid usage or acute hospital in-patient use were excluded. Databases searched included PubMed, EMBASE, Web of Science and the grey literature. Results The search identified 2253 peer-reviewed publications, with 34 requiring full-text review. Of these, 20 were included in the final qualitative analysis, in addition to four publications from the grey literature. Most studies included analysed prescription claims data for medicines dispensed via Australia's national medicines subsidy scheme (the Pharmaceutical Benefits Scheme). Although data sources were good quality, all prevalence estimates were at least at moderate risk of bias, predominantly due to incompleteness of data or potential confounding. Included publications demonstrated a significant rise in opioid use up to 2017 (including a 15-fold increase in prescriptions dispensed over the 20 years to 2015), predominantly driven by a sharp rise in oxycodone use. Although opioid prescription numbers continue to escalate, usage, as measured by oral morphine equivalent per capita, may have plateaued since 2014. Codeine remains the most prevalently obtained opioid, followed by oxycodone and tramadol. There was a substantial delay (median 30 months; interquartile range 20-37 months) to publication of opioid usage data from time of availability. Conclusions Australia has experienced a marked increase in opioid prescribing since the 1990s. Current published literature is restricted to incomplete, delayed and historical data, limiting the ability of clinicians and policy makers to intervene appropriately. What is known about the topic? Opioid prescriptions in Australia have continued to increase since the 1990s and may be mirroring the epidemic being seen in the US. What does this paper add? This paper systematically identifies all publications that have examined the prevalence of prescription opioid use in Australia since 2000, and only identified prevalence estimates that were at moderate or high risk of bias, and found significant delays to publication of these estimates. What are the implications for practitioners? Because published literature on the prevalence of prescription opioid consumption is restricted to incomplete, delayed and historical data, the ability of clinicians and policy makers to appropriately intervene to curb prescription opioid use is limited. A national policy of real-time monitoring and reporting of opioid prescribing may support improvements in practice.
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Affiliation(s)
- Peter J Donovan
- Department of Clinical Pharmacology, Royal Brisbane and Women's Hospital, cnr Butterfield Street and Bowen Bridge Road, Herston, Qld 4029, Australia. ; and The University of Queensland Faculty of Medicine and Biomedical Sciences, 288 Herston Road, Herston, Qld 4066, Australia. ; and Corresponding author.
| | - David Arroyo
- The University of Queensland Faculty of Medicine and Biomedical Sciences, 288 Herston Road, Herston, Qld 4066, Australia.
| | - Champika Pattullo
- Department of Clinical Pharmacology, Royal Brisbane and Women's Hospital, cnr Butterfield Street and Bowen Bridge Road, Herston, Qld 4029, Australia.
| | - Anthony Bell
- The University of Queensland Faculty of Medicine and Biomedical Sciences, 288 Herston Road, Herston, Qld 4066, Australia. ; and The Wesley Hospital, 451 Coronation Drive, Auchenflower, Brisbane, Qld 4066, Australia.
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17
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Picco L, Middleton M, Bruno R, Kowalski M, Nielsen S. Validity and Reliability of the Computer-Administered Routine Opioid Outcome Monitoring (ROOM) Tool. PAIN MEDICINE 2020; 21:3645-3654. [PMID: 33094345 DOI: 10.1093/pm/pnaa297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The Routine Opioid Outcome Monitoring (ROOM) tool measures outcomes with opioids using an established framework which includes domains such as pain, mood, opioid use disorder, alcohol use, and constipation. This study aims to validate and establish the test-retest reliability of the computer-administered ROOM tool. DESIGN AND SETTING Cross-sectional analysis of an online sample. SUBJECTS Participants comprised those with chronic noncancer pain who regularly used prescription opioids. METHODS Participants self-completed the online ROOM tool along with other validated measures (validation questionnaire), and those who were agreeable also completed the online test-retest questionnaire approximately two weeks later. Subcomponents of the ROOM tool (i.e., pain, mood, alcohol use, opioid use disorder, and constipation) were validated against longer measures of the same construct using Pearson correlation coefficients. Intraclass correlation coefficients were used to assess the stability of the ROOM tool over time. RESULTS A total of 324 participants completed the validation questionnaire, of whom 260 also completed the test-retest questionnaire. The opioid use disorder domain showed good sensitivity (73.6) and specificity (75.8) against the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, any opioid use disorder. All ROOM components showed moderate correlation (r = 0.55-0.73) with their longer counterparts. Test-retest reliability was fair (0.58-0.75), indicating that responses were relatively stable over time. Reliability did vary, however, based on the components being measured and how certain tools were scored. CONCLUSION The computer-administered ROOM tool is a valid approach for brief monitoring of outcomes with prescribed opioids in primary care settings and appears to be acceptable to people who are using prescribed opioids for chronic pain.
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Affiliation(s)
- Louisa Picco
- Monash Addiction Research Centre, Monash University Peninsula Campus, Frankston, Victoria, Australia
| | - Melissa Middleton
- Monash Addiction Research Centre, Monash University Peninsula Campus, Frankston, Victoria, Australia
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Michala Kowalski
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Monash University Peninsula Campus, Frankston, Victoria, Australia
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
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Holland TJ, Penm J, Johnson J, Sarantou M, Chaar BB. Stakeholders' Perceptions of Factors Influencing the Use of Take-Home-Naloxone. PHARMACY 2020; 8:pharmacy8040232. [PMID: 33287294 PMCID: PMC7768544 DOI: 10.3390/pharmacy8040232] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 11/16/2022] Open
Abstract
Background and Aims: Opioid associated death and overdose is a growing burden in societies all over the world. In recent years, legislative changes have increased access to naloxone in the take-home setting for use by patients with a substance use disorder and bystanders, to prevent opioid overdose deaths. However, few studies have explored the factors influencing the uptake by its multiple stakeholders. The aim of this scoping review was to explore the factors influencing the use of take-home naloxone from the perspectives of different stakeholders. Methods: A scoping review methodology was adopted with a systematic search of databases EMBASE, MEDLINE and PubMed. A variation of the search words “naloxone”, “opioid” and “overdose” were used in each database. The articles were screened according to the predetermined inclusion/exclusion criteria and categorized based on their key perspective or target population. Results: The initial database search yielded a total of 1483 articles. After a series of screening processes, 51 articles were included for analysis. Two key stakeholder perspectives emerged: patients and bystanders (n = 36), and healthcare professionals (n = 15). Within the patient and bystander group, a strong consensus arose that there were positive outcomes from increased access to take-home naloxone and relevant training programs. Despite these positive outcomes, some healthcare professionals were concerned that take-home naloxone would encourage high-risk opioid use. Conclusion: Take-home naloxone is slowly being introduced into community practice, with a sense of enthusiasm from patients and bystanders. There are still a number of barriers that need to be addressed from healthcare professionals’ perspective. Future research should be aimed at emergency care professionals outside of the US, who are most experienced with naloxone and its potential impact on the community.
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Affiliation(s)
- Taylor J. Holland
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW 2006, Australia; (T.J.H.); (J.P.)
| | - Jonathan Penm
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW 2006, Australia; (T.J.H.); (J.P.)
- Department of Pharmacy, Prince of Wales Hospital, Randwick, NSW 2031, Australia
| | - Jacinta Johnson
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA 5000, Australia;
| | - Maria Sarantou
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia;
| | - Betty B. Chaar
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Camperdown, NSW 2006, Australia; (T.J.H.); (J.P.)
- Correspondence: ; Tel.: +61-2-9036-7101 or +61-425-210-547
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Routine opioid outcome monitoring in community pharmacy: Outcomes from an open-label single-arm implementation-effectiveness pilot study. Res Social Adm Pharm 2020; 16:1694-1701. [DOI: 10.1016/j.sapharm.2020.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/12/2020] [Accepted: 02/18/2020] [Indexed: 12/13/2022]
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20
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Opioid Use and Appropriateness of Supply After Total Knee or Hip Arthroplasty: An Australian Perspective. J Am Acad Orthop Surg 2020; 28:e980-e989. [PMID: 32195829 DOI: 10.5435/jaaos-d-19-00789] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 02/17/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Effective pain management after joint arthroplasty is essential for optimal participation in rehabilitation. However, this needs to be balanced with potential risks associated with opioid use and community exposure. The aim of this study was to evaluate opioid use and appropriateness of supply on discharge after total knee arthroplasty or total hip arthroplasty at a major Australian health service. METHODS A prospective observational study was undertaken at an Australian 980-bed metropolitan health service. Patient interviews were conducted 3 weeks after hospital discharge to evaluate analgesic management and functional outcomes. The primary end point was the number of hospital-supplied opioid pills remaining 3 weeks postdischarge. Secondary end points included (1) factors associated with opioid use 3 weeks postdischarge, (2) opioid use in patients with poor functional outcomes, and (3) proportion of opioid naive patients who became chronic opioid users. RESULTS One hundred forty patients were included, and 137 were supplied opioids on discharge. At 3 weeks postdischarge, the median number of opioid pills remaining was 0 (interquartile range 0 to 8). There were 77 patients (56.2%) still taking opioids; surgery type, opioid use before admission, and the number of "as required" doses used 24 hours before discharge were independent predictors of opioid continuation. Patients with poor functional outcomes were supplied with more opioids on discharge, often not satisfied with the quantity supplied and more likely to be taking opioids 3 weeks postdischarge. There were 5 of 93 opioid naive patients (5.3%) who developed chronic opioid usage. DISCUSSION More than half of the patients undergoing total knee arthroplasty or total hip arthroplasty were still using opioids at 3 weeks postdischarge. Most patients were not supplied with excessive quantities at discharge. Future research should focus on identifying patients at risk of prolonged opioid use and improving the transition of these patients into the community. LEVEL OF EVIDENCE Level II-Prognostic study = prospective observational study.
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Fitzsimons K, Ferguson C, Jovanovska T, Koay A, Davies CR. Opioid related medication incidents in Western Australia public hospitals: types, causes and level of harm. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2020. [DOI: 10.1002/jppr.1689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Kerry Fitzsimons
- Office of Patient Safety and Clinical Quality WA Department of Health East Perth Australia
| | - Chantal Ferguson
- Office of Patient Safety and Clinical Quality WA Department of Health East Perth Australia
| | - Tatjana Jovanovska
- Office of Patient Safety and Clinical Quality WA Department of Health East Perth Australia
| | - Audrey Koay
- Office of Patient Safety and Clinical Quality WA Department of Health East Perth Australia
| | - Christina R. Davies
- School of Allied Health The University of Western Australia Crawley Australia
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22
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Picco L, Middleton M, Bruno R, Kowalski M, Nielsen S. Validation of the OWLS, a Screening Tool for Measuring Prescription Opioid Use Disorder in Primary Care. PAIN MEDICINE 2020; 21:2757-2764. [PMID: 32869062 DOI: 10.1093/pm/pnaa275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The OWLS is a screening tool for prescription opioid use disorder designed for use in primary care. This study aimed to confirm the optimal wording, scoring methods, and cutoff for the OWLS. DESIGN AND SETTING Cross-sectional analysis of an online sample. SUBJECTS Participants comprised those with chronic noncancer pain who regularly used prescription opioids. METHODS Eligible participants self-completed an online version of the OWLS prescription opioid use disorder screening tool and the Composite International Diagnostic Interview Substance Abuse module. Receiver operating characteristics were calculated for three scoring methods for the OWLS, and these were compared with DSM-5 classification of any use disorder and moderate to severe opioid use disorder. RESULTS Among the sample (N = 324), utilizing scoring method (i) (i.e., positive endorsement ≥ response option "a little bit") and a cutoff of 3 increased the percentage of correctly classified participants, with concurrent increases in specificity and decreases in false discovery rate, and false positive rate. CONCLUSION OWLS utilizing scoring method (i) with a cutoff of 3 was shown to be the optimal version and scoring method of this tool. This represents a time-efficient, simple scoring method, allowing for quick and accurate screening for opioid use disorder to occur.
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Affiliation(s)
- Louisa Picco
- Monash Addiction Research Centre, Monash University Peninsula Campus, Frankston, Victoria, Australia
| | - Melissa Middleton
- Monash Addiction Research Centre, Monash University Peninsula Campus, Frankston, Victoria, Australia
| | - Raimondo Bruno
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.,School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Michala Kowalski
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Monash University Peninsula Campus, Frankston, Victoria, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
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Menz HB, Harrison C, Britt H, Whittaker GA, Landorf KB, Munteanu SE. Management of Hallux Valgus in General Practice in Australia. Arthritis Care Res (Hoboken) 2020; 72:1536-1542. [DOI: 10.1002/acr.24075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 09/17/2019] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Helena Britt
- University of Sydney Sydney New South Wales Australia
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Abstract
Aim: The review aimed to identify factors influencing opioid prescribing as regular pain-management medication for older people. Background: Chronic pain occurs in 45%–85% of older people, but appears to be under-recognised and under-treated. However, strong opiate prescribing is more prevalent in older people, increasing at the fastest rate in this age group. Methods: This review included all study types, published 1990–2017, which focused on opioid prescribing for pain management among older adults. Arksey and O’Malley’s framework was used to scope the literature. PubMed, EBSCO Host, the UK Drug Database, and Google Scholar were searched. Data extraction, carried out by two researchers, included factors explaining opioid prescribing patterns and prescribing trends. Findings: A total of 613 papers were identified and 53 were included in the final review consisting of 35 research papers, 10 opinion pieces and 8 grey literature sources. Factors associated with prescribing patterns were categorised according to whether they were patient-related, prescriber-driven, or system-driven. Patient factors included age, gender, race, and cognition; prescriber factors included attitudes towards opioids and judgements about ‘normal’ pain; and policy/system factors related to the changing policy landscape over the last three decades, particularly in the USA. Conclusions: A large number of context-dependent factors appeared to influence opioid prescribing for chronic pain management in older adults, but the findings were inconsistent. There is a gap in the literature relating to the UK healthcare system; the prescriber and the patient perspective; and within the context of multi-morbidity and treatment burden.
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25
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Gisev N, Nielsen S, Campbell G, Santo T, Mant A, Bruno R, Cohen M, Hall WD, Larance B, Lintzeris N, Farrell M, Degenhardt L. Antidepressant Use Among People Prescribed Opioids for Chronic Noncancer Pain. PAIN MEDICINE 2020; 20:2450-2458. [PMID: 30861530 DOI: 10.1093/pm/pnz009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Although depression and chronic pain often coexist, few studies have examined antidepressant use among people with pain. This study examines the prevalence and characteristics associated with antidepressant use among people prescribed opioids for chronic noncancer pain (CNCP). DESIGN Baseline data from a prospective cohort study. SETTING Australian community. SUBJECTS A total of 1166 people prescribed opioids for CNCP. METHODS Baseline data collection consisted of a self-completed seven-day medication diary and telephone interview to collect information on sociodemographic characteristics and mental/physical health using validated questionnaires. Logistic regression was used to examine characteristics associated with antidepressant use, reporting adjusted odds ratios (AORs) and 95% confidence intervals (CIs). RESULTS Of the 1166 participants, 668 (57.3%) were female, and the median (interquartile range) age was 59 (49-68) years. About half the cohort (N = 637, 54.6%) used antidepressants. Of these, 329 (51.7%) reported moderate to severe depression. Amitriptyline was the most commonly used antidepressant (17.3%). Factors independently associated with antidepressant use were being female (AOR = 1.47, 95% CI = 1.13-1.92), more years lived in pain (AOR = 1.01, 95% CI = 1.00-1.02), and use of nonopioid analgesics (AOR = 1.34, 95% CI = 1.01-1.78), benzodiazepines and related drugs (AOR = 1.84, 95% CI = 1.36-2.49), antiepileptics (AOR = 1.86, 95% CI = 1.38-2.51), and antipsychotics (AOR = 2.15, 95% CI = 1.22-3.77). CONCLUSIONS Antidepressant use is common among people with CNCP prescribed opioids. Those using antidepressants were more likely to use other psychotropic medicines concurrently, highlighting that they are a high-risk population requiring comprehensive assessment to optimize outcomes and reduce potential harms from polypharmacy.
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Affiliation(s)
- Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Suzanne Nielsen
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia.,Monash Addiction Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Gabrielle Campbell
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Thomas Santo
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Andrea Mant
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Raimondo Bruno
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Milton Cohen
- St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Sydney, New South Wales, Australia
| | - Wayne D Hall
- Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, Queensland, Australia.,National Addiction Centre, Kings College London, London, UK
| | - Briony Larance
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia.,School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Nicholas Lintzeris
- Discipline of Addiction Medicine, The University of Sydney, Sydney, New South Wales, Australia.,The Langton Centre, South East Sydney Local Health District Drug and Alcohol Services, Sydney, New South Wales, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia.,School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Prathivadi P, Barton C, Mazza D. Qualitative insights into the opioid prescribing practices of Australian GP. Fam Pract 2020; 37:412-417. [PMID: 31768532 DOI: 10.1093/fampra/cmz083] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Over the last three decades, Australian opioid-prescribing rates and related morbidity and mortality have dramatically increased. Opioids are frequently prescribed by general practitioners (GPs) to manage chronic non-cancer pain, despite evidence-based recommendations from the Centre for Disease Control, National Institute for Health and Care Excellence and World Health Organization widely cautioning their use. Little is known about the factors influencing the opioid prescribing decisions of Australian GPs, especially when not evidence based. OBJECTIVE To explore the opioid prescribing knowledge, attitudes and practices of Australian GPs. METHODS Semi-structured interviews with 20 GPs recruited from the Monash University practice-based research network in metropolitan, southeastern Melbourne. Thematic analysis was used to identify emergent themes. Data were managed using QSR NVivo. Ethics approval was granted by Monash University. RESULTS Three key themes emerged. GP attitudes towards opioid use for chronic pain varied by age of patient and goals for therapy. Use of opioids for elderly patients was positively perceived. GPs were reluctant to use opioids in younger patients due to fears of addiction and difficulty weaning. GPs felt obliged to prescribe opioids recommended by specialists, even if they believed the opioids were unsafe. CONCLUSION This study identified and described the patient-centred nature of GP opioid prescribing decisions. Patient age and perceived age-related opioid harm were important factors influencing prescribing decisions. Future work should inform interventions that value GP autonomy while still encouraging a collaborative inter-speciality approach to managing chronic pain patients with opioids.
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Affiliation(s)
- Pallavi Prathivadi
- Department of General Practice, Monash University, Notting Hill, Australia
| | - Chris Barton
- Department of General Practice, Monash University, Notting Hill, Australia
| | - Danielle Mazza
- Department of General Practice, Monash University, Notting Hill, Australia
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Adewumi AD, Maravilla JC, Alati R, Hollingworth SA, Hu X, Loveday B, Connor JP. Duration of opioid use and association with socioeconomic status, daily dose and formulation: a two-decade population study in Queensland, Australia. Int J Clin Pharm 2020; 43:340-350. [PMID: 32556897 DOI: 10.1007/s11096-020-01079-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 06/04/2020] [Indexed: 01/25/2023]
Abstract
Background There is an association between the duration of prescription opioids use and an increased risk of serious harm, often unintentional. Objective (1) Describe the trends in duration of prescription opioids dispensing and, (2) determine the risk of long-term use (≥4 months) based on patients' socioeconomic status, daily dose in oral daily morphine milligram equivalent, and opioid formulation. Setting Residents of Queensland (2,827,727), Australia from the age 18 years and who were dispensed pharmaceutical opioids from 1 January 1997 to 31 December 2018. Method Retrospective, longitudinal population-based analysis using data obtained from the Monitoring of Drugs of Dependence system of the Monitored Medicines Unit of Queensland Health. Main outcome measure Contribution of socioeconomic status, and daily dose and opioid formulation (modified-release or immediate-release) to the risk of long-term opioid use. Results There was little difference between the number of patients dispensed opioids for ≥4 months and ≤3 months between 1997 and 2011. Thereafter, the number for those using opioids long-term increased. The highest risk of having opioids dispensed for ≥4 months were for patients in the lowest level of socioeconomic status (adjusted odds ratio 1.36; 95% CI, 1.34, 1.38), compared to people in the highest socioeconomic status areas, followed by the low-socioeconomic status areas, mid-socioeconomic status areas, and high-socioeconomic status areas respectively. The risk of being dispensed prescription opioids for ≥4 months significantly increased as the dose increased: adjusted odds ratio 1.73; 95% CI, 1.71, 1.75, adjusted odds ratio 1.89; 95% CI, 1.87, 1.92, and adjusted odds ratio 3.63; 95% CI, 3.58, 3.69 for the ≥20 to <50 oral daily morphine milligram equivalent, ≥50 to <100 oral daily morphine milligram equivalent and ≥100 oral daily morphine milligram equivalent dose categories, respectively. Conclusion Higher doses and living in a low socioeconomic status areas were associated with increased risk of long-term dispensing of opioid prescriptions.
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Affiliation(s)
- Adeleke D Adewumi
- Maryborough Hospital Pharmacy, Wide Bay Hospital and Health Service, 185 Walker Street Maryborough 4650, Herston, QLD, Australia. .,Discipline of Psychiatry, The University of Queensland, Herston, QLD, 4029, Australia. .,School of Clinical Medicine - Rural Clinical School, The University of Queensland, 2-4 Medical Place, Urraween, QLD, 4655, Australia.
| | - Joemer C Maravilla
- Institute for Social Science Research, The University of Queensland, 80 Meiers Rd, Indooroopilly, QLD, 4068, Australia
| | - Rosa Alati
- School of Public Health, Curtin University, Kent Street, Bentley Campus, Perth, WA, 6845, Australia
| | - Samantha A Hollingworth
- School of Pharmacy, The University of Queensland, 20 Cornwall St, Woolloongabba, QLD, 4102, Australia
| | - Xuelei Hu
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Bill Loveday
- Monitored Medicines Unit, Chief Medical Officer and Healthcare Regulation Branch, Department of Health, Brisbane, QLD, 4000, Australia
| | - Jason P Connor
- Discipline of Psychiatry, The University of Queensland, Herston, QLD, 4029, Australia.,Centre for Youth Substance Abuse Research, The University of Queensland, 17 Upland Road, St Lucia, QLD, 4067, Australia
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What predicts pharmacists' engagement with opioid-outcome screening? Secondary analysis from an implementation study in community pharmacy. Int J Clin Pharm 2020; 43:420-429. [PMID: 32533428 DOI: 10.1007/s11096-020-01074-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/28/2020] [Indexed: 10/24/2022]
Abstract
Background Pharmacists have a key role to play in identifying and responding to emerging clinical problems with prescribed opioids. A pilot study in Australia examined the implementation of screening and brief intervention (Routine Opioid Outcome Monitoring [ROOM]) to identify and respond to opioid-related problems in community pharmacies. In this implementation study, the rate of screening varied considerably between pharmacies. Objective The aim of this study was to examine pharmacist characteristics associated with implementation of ROOM. Setting Community pharmacies in Victoria and New South Wales, Australia. Methods We implemented a validated computer-facilitated screening (ROOM), combined with brief intervention for opioid-related problems based on a widely accepted framework for monitoring outcomes. In this analysis, we examined the correlates of ROOM completion for individual pharmacists. Negative binomial regression was used to identify baseline predictors of greater screening, with the number of ROOM screens as the dependent (outcome) variable and pharmacist demographics, knowledge, confidence and comfort responding to prescription opioids problems, and attitudes towards evidence based practice examined as independent (predictor) variables. Main outcome measure Number of screens completed by an individual pharmacist as reported in follow-up surveys by pharmacist. Results Fewer years of practice was associated with a greater number of screenings conducted. On average, each additional decade of practice was associated with a 31% (95% CI 0%, 53%) reduction in the number of screenings undertaken by pharmacists. A multivariable analysis revealed that each additional decade practicing, lower knowledge of naloxone and lower confidence in identifying unmanaged pain were all independently associated with reduced engagement in screening after controlling for other variables. Conclusion Findings from this pilot study identified potential barriers to implementing opioid outcome monitoring. Further studies could test different groups of community pharmacists' experience of different barriers when implementing monitoring outcomes with prescribed opioids, to inform future implementation and clinical practice.
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Potential for Harm Associated with Discharge Opioids After Hospital Stay: A Systematic Review. Drugs 2020; 80:573-585. [DOI: 10.1007/s40265-020-01294-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Allen ML, Kim CC, Braat S, Jones K, Winter N, Hucker TR, Chia A, Lang C, Brooks SL, Williams DL. Post-discharge opioid use and handling in surgical patients: A multicentre prospective cohort study. Anaesth Intensive Care 2020; 48:36-42. [DOI: 10.1177/0310057x19895019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Our aim was to determine the frequency and characteristics of post-surgery prescription of opioid medication and to describe patients’ handling of discharge opioid medications. We performed a multicentre prospective cohort study of adult patients undergoing elective or emergency surgery with a postoperative stay of one or more nights, with phone follow-up at two weeks after hospital discharge. The main outcome measures included the proportion of patients prescribed discharge opioid medications, post-discharge opioid use, opioid storage and disposal. Of the 1450 eligible surgical patients, opioids were dispensed on discharge to 858 (59%, 95% confidence interval (CI) (57%–62%)), with immediate-release oxycodone the most common medication. Of the 581 patients who were discharged with opioid medication and completed follow-up, 27% were still requiring opioids two weeks after discharge. Post-discharge opioid consumption was highly variable in the study cohort. The majority (70%) of patients had leftover opioids and only a small proportion (5%) reported disposal of the surplus. In a multivariate model, patients with characteristics of age 45 years or less (odds ratio, OR = 1.78, 95% CI (1.36–2.33) versus older than 45 years), American Society of Anesthesiologists’ physical status (ASA) scores of 1 or 2 (OR = 1.96, 95% CI (1.52–2.53) versus ASA score 3 to 5), higher anticipated surgical pain (OR = 1.45, 95% CI (1.08–1.94) severe versus moderate, OR = 17.48, 95% CI (5.79–52.69) severe versus nil/mild) and public funding status (OR = 1.89, 95% CI (1.36–2.64) versus other) were more likely ( P < 0.001) to receive discharge opioids. Post-surgery prescription of opioids is common and supply is often excessive. Post-discharge opioid handling included suboptimal storage and disposal.
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Affiliation(s)
- Megan L Allen
- Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, Australia
- Department of Anaesthetics, Perioperative Medicine and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Anaesthesia, Pain and Perioperative Medicine Unit, The University of Melbourne, Melbourne, Australia
| | - Charles C Kim
- Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, Australia
| | - Sabine Braat
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
- Melbourne Clinical and Translational Science Platform, The University of Melbourne, Melbourne, Australia
| | - Karin Jones
- Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, Australia
- Department of Anaesthesia, The Royal Women’s Hospital, Melbourne, Australia
| | - Noam Winter
- Department of Anaesthesia and Pain Medicine, Western Health, Footscray Hospital, Footscray, Australia
| | - Timothy R Hucker
- Department of Anaesthetics, Perioperative Medicine and Pain Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Angela Chia
- Department of Anaesthesia, The Royal Women’s Hospital, Melbourne, Australia
| | - Coran Lang
- Department of Anaesthesia and Pain Medicine, Western Health, Footscray Hospital, Footscray, Australia
| | - Sally L Brooks
- Department of Pharmacy, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Daryl L Williams
- Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, Australia
- Department of Anaesthesia, Pain and Perioperative Medicine Unit, The University of Melbourne, Melbourne, Australia
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Nielsen S, Picco L, Campbell G, Lintzeris N, Larance B, Farrell M, Degenhardt L, Bruno R. Development of a Brief Patient-Administered Screening Tool for Prescription Opioid Dependence for Primary Care Settings. PAIN MEDICINE (MALDEN, MASS.) 2020; 21:e79-e88. [PMID: 31591644 PMCID: PMC8204889 DOI: 10.1093/pm/pnz213] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To develop a short, patient-administered screening tool that will allow for earlier assessment of prescription opioid dependence (often referred to as addiction) in primary care settings. DESIGN AND SETTING Cross-sectional analysis (N = 1,134) from the two-year time point of the Pain and Opioids IN Treatment (POINT) cohort was used in the scale development. SUBJECTS Participants who completed two-year interviews in the POINT study, a prospective cohort study that followed people with chronic noncancer pain over a five-year period, and who were prescribed strong opioids for a minimum of six weeks at baseline. METHODS An advisory committee provided advice on wording and content for screening in primary care settings. Univariate logistic regression identified individual items that were significantly associated with meeting ICD-11 criteria for prescription opioid dependence. Exploratory and confirmatory factor analysis (EFA and CFA) were conducted, and items were reduced to identify a small item set that were discriminative and shared a simple underlying structure. RESULTS Sixty-four variables associated with ICD-11 criteria for prescription opioid dependence were initially identified. Four rounds of EFA were performed, resulting in five items remaining. CFA identified two possible four-item combinations, with the final combination chosen based on greater item endorsement and the results of goodness-of-fit indices. CONCLUSIONS Addressing prescription opioid dependence is an important part of the global public health challenge surrounding rising opioid-related harm. This study addresses an important initial requisite step to develop a brief screening tool. Further studies are required to validate the tool in clinical settings.
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Affiliation(s)
- Suzanne Nielsen
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, New South Wales, Australia
- Monash Addiction Research Centre, Monash University Peninsula Campus, Frankston, Victoria, Australia
| | - Louisa Picco
- Monash Addiction Research Centre, Monash University Peninsula Campus, Frankston, Victoria, Australia
| | - Gabrielle Campbell
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Nicholas Lintzeris
- Discipline of Addiction Medicine, University of Sydney, Sydney, New South Wales, Australia
- The Langton Centre, South East Sydney Local Health District (SESLHD) Drug and Alcohol Services, Sydney, New South Wales, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, New South Wales, Australia
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales Sydney, Sydney, New South Wales, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Raimondo Bruno
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Choi PM, Tscharke B, Samanipour S, Hall WD, Gartner CE, Mueller JF, Thomas KV, O'Brien JW. Social, demographic, and economic correlates of food and chemical consumption measured by wastewater-based epidemiology. Proc Natl Acad Sci U S A 2019; 116:21864-21873. [PMID: 31591193 PMCID: PMC6815118 DOI: 10.1073/pnas.1910242116] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Wastewater is a potential treasure trove of chemicals that reflects population behavior and health status. Wastewater-based epidemiology has been employed to determine population-scale consumption of chemicals, particularly illicit drugs, across different communities and over time. However, the sociodemographic or socioeconomic correlates of chemical consumption and exposure are unclear. This study explores the relationships between catchment specific sociodemographic parameters and biomarkers in wastewater generated by the respective catchments. Domestic wastewater influent samples taken during the 2016 Australian census week were analyzed for a range of diet, drug, pharmaceutical, and lifestyle biomarkers. We present both linear and rank-order (i.e., Pearson and Spearman) correlations between loads of 42 biomarkers and census-derived metrics, index of relative socioeconomic advantage and disadvantage (IRSAD), median age, and 40 socioeconomic index for area (SEIFA) descriptors. Biomarkers of caffeine, citrus, and dietary fiber consumption had strong positive correlations with IRSAD, while tramadol, atenolol, and pregabalin had strong negative correlation with IRSAD. As expected, atenolol and hydrochlorothiazide correlated positively with median age. We also found specific SEIFA descriptors such as occupation and educational attainment correlating with each biomarker. Our study demonstrates that wastewater-based epidemiology can be used to study sociodemographic influences and disparities in chemical consumption.
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Affiliation(s)
- Phil M Choi
- Queensland Alliance for Environmental Health Science, The University of Queensland, Woolloongabba, QLD 4102, Australia;
| | - Benjamin Tscharke
- Queensland Alliance for Environmental Health Science, The University of Queensland, Woolloongabba, QLD 4102, Australia
| | | | - Wayne D Hall
- Centre for Youth Substance Abuse Research, The University of Queensland, Herston, QLD 4029, Australia
| | - Coral E Gartner
- Queensland Alliance for Environmental Health Science, The University of Queensland, Woolloongabba, QLD 4102, Australia
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
| | - Jochen F Mueller
- Queensland Alliance for Environmental Health Science, The University of Queensland, Woolloongabba, QLD 4102, Australia
| | - Kevin V Thomas
- Queensland Alliance for Environmental Health Science, The University of Queensland, Woolloongabba, QLD 4102, Australia
| | - Jake W O'Brien
- Queensland Alliance for Environmental Health Science, The University of Queensland, Woolloongabba, QLD 4102, Australia
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Du W, Chong S, McLachlan AJ, Luo L, Glasgow N, Gnjidic D. Adverse drug reactions due to opioid analgesic use in New South Wales, Australia: a spatial-temporal analysis. BMC Pharmacol Toxicol 2019; 20:55. [PMID: 31488223 PMCID: PMC6728962 DOI: 10.1186/s40360-019-0333-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/26/2019] [Indexed: 11/10/2022] Open
Abstract
Background Pharmaceutical opioid analgesic use continues to rise and is associated with potentially preventable harm including hospitalisation for adverse drug reactions (ADRs). Spatial detection of opioid-related ADRs can inform future intervention strategies. We aimed to investigate the geographical disparity in hospitalised ADRs related to opioid analgesic use, and to evaluate the difference in patient characteristics between areas inside and outside the geographic clusters. Methods We used the all-inclusive Admitted Patient Dataset for an Australian state (New South Wales, NSW) to identify patients admitted for opioid-related ADRs over a 10-year period (July 2004 to June 2014). A space-time analysis was conducted using Kulldroff’s scan statistics to identify statistically significant spatial clusters over time. Relative risk (RR) was computed with p-value based on Monte Carlo Simulation. Chi-square test was used to compare proportional difference in patient clustering. Results During the study period, we identified four statistically significant geographic clusters (RRs: 1.63–2.17) during 2004–08; and seven clusters (RRs: 1.23–1.69) during the period 2009–14. While identified high-risk clusters primarily covered areas with easier access to health services, those associated with socioeconomically disadvantaged areas and individuals with mental health disorders experienced more unmet healthcare needs for opioid analgesic safety than those from the rest of the State. Older people (≥65 years and over) accounted for 62.7% of the total study population and were more susceptible to opioid-related ADRs than younger people,. In the first five-year period the clusters included a greater proportion of people with cancer in contrast to the second five-year period in which there was a lesser proportion of people with cancer. Conclusions These results suggest that there is significant spatial-temporal variation in opioid-related ADRs and future interventions should target vulnerable populations and high-risk geographical areas to improve safer use of pharmaceutical opioid analgesics.
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Affiliation(s)
- Wei Du
- Research School of Population Health, Australian National University, Building 63, Eggleston Road, Acton, ACT, 2601, Australia.
| | - Shanley Chong
- South Western Sydney Area Health Services, Sydney, Australia
| | - Andrew J McLachlan
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Lan Luo
- Research School of Population Health, Australian National University, Building 63, Eggleston Road, Acton, ACT, 2601, Australia
| | - Nicholas Glasgow
- Research School of Population Health, Australian National University, Building 63, Eggleston Road, Acton, ACT, 2601, Australia
| | - Danijela Gnjidic
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Charles Perkins Centre, University of Sydney, Sydney, Australia
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Larance B, Campbell G, Moore T, Nielsen S, Bruno R, Lintzeris N, Cohen M, Hall W, Mattick R, O'Donnell C, Degenhardt L. Concerns and Help-Seeking Among Patients Using Opioids for Management of Chronic Noncancer Pain. PAIN MEDICINE 2019; 20:758-769. [PMID: 29762767 DOI: 10.1093/pm/pny078] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The safety and efficacy of long-term opioid treatment for chronic noncancer pain (CNCP) remains controversial. This study examined whether patients who report problematic opioid use sought help and/or perceived barriers to help-seeking. METHODS Data were collected from 1,086 people prescribed opioids for CNCP via a large prospective cohort called the Pain and Opioids IN Treatment (POINT) study. Patients' characteristics and help-seeking were examined according to scores on the Prescribed Opioids Difficulties Scale (PODS). RESULTS Participants scoring "intermediate" (17%) or "high" (30%) on the PODS were younger and reported more complex pain presentations, higher opioid doses, poorer physical health, moderate to severe anxiety and depression, aberrant behavior, past month opioid use disorder and help-seeking (compared with the "low" PODS group, 53%). One-quarter (26%) had sought help, most commonly from a primary care physician, specialist pain clinic, family member/partner, counselor/psychologist, and the Internet. Participants in the "high" PODS group were more likely to have sought help from an alcohol or other drug service, addiction specialist, or drug information helpline. Common barriers to help-seeking were desire for self-management and concern that their opioid treatment may be discontinued. Although 35% met criteria for likely opioid use disorder, only 4.8% reported lifetime treatment with methadone or buprenorphine; participants' ratings indicated significant perceived stigma associated with these medications. CONCLUSIONS The PODS is effective in identifying patients who are concerned about their opioid use. Strategies to address stigma related to drug treatment, including better integration of primary health, specialist pain, and addiction services, are important in reducing opioid-related harm.
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Affiliation(s)
- Briony Larance
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia
| | - Gabrielle Campbell
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia
| | - Teleri Moore
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia
| | - Suzanne Nielsen
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia.,The Langton Centre, South East Sydney Local Health District (SESLHD) Drug and Alcohol Services, Sydney New South Wales, Australia
| | - Raimondo Bruno
- School of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia
| | - Nicholas Lintzeris
- The Langton Centre, South East Sydney Local Health District (SESLHD) Drug and Alcohol Services, Sydney New South Wales, Australia.,Addiction Medicine, Central Clinical School, University of Sydney, Camperdown, New South Wales, Australia
| | - Milton Cohen
- St Vincent's Clinical School, UNSW Australia, Sydney, New South Wales, Australia
| | - Wayne Hall
- Centre for Youth Substance Abuse, University of Queensland, Queensland, Australia
| | - Richard Mattick
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia
| | - Courtney O'Donnell
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Australia, Sydney, New South Wales, Australia
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35
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Routine opioid outcome monitoring in community pharmacy: Pilot implementation study protocol. Res Social Adm Pharm 2019; 15:1047-1055. [DOI: 10.1016/j.sapharm.2018.10.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 08/10/2018] [Accepted: 10/17/2018] [Indexed: 11/19/2022]
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Harms associated with extramedical use of prescription opioid analgesics in Australia: A scoping review. Res Social Adm Pharm 2019; 15:925-935. [DOI: 10.1016/j.sapharm.2018.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/02/2018] [Indexed: 01/01/2023]
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Roughead EE, Lim R, Ramsay E, Moffat AK, Pratt NL. Persistence with opioids post discharge from hospitalisation for surgery in Australian adults: a retrospective cohort study. BMJ Open 2019; 9:e023990. [PMID: 30992289 PMCID: PMC6500207 DOI: 10.1136/bmjopen-2018-023990] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To determine time to opioid cessation post discharge from hospital in persons who had been admitted to hospital for a surgical procedure and were previously naïve to opioids. DESIGN, SETTING AND PARTICIPANTS Retrospective cohort study using administrative health claims database from the Australian Government Department of Veterans' Affairs (DVA). DVA gold card holders aged between 18 and 100 years who were admitted to hospital for a surgical admission between 1 January 2014 and 30 December 2015 and naïve to opioid therapy prior to admission were included in the study. Gold card holders are eligible for all health services that DVA funds. MAIN OUTCOME MEASURES The outcome of interest was time to cessation of opioids, with follow-up occurring over 12 months. Cessation was defined as a period without an opioid prescription that was equivalent to three times the estimated supply duration. The proportion who became chronic opioid users was defined as those who continued taking opioids for greater than 90 days post discharge. Cumulative incidence function with death as a competing event was used to determine time to cessation of opioids post discharge. RESULTS In 2014-2015, 24 854 persons were admitted for a surgical admission. In total 3907 (15.7%) were discharged on opioids. In total 3.9% of those discharged on opioids became chronic users of opioids. The opioid that the patients were most frequently discharged with was oxycodone; oxycodone alone accounted for 43%, while oxycodone with naloxone accounted for 8%. CONCLUSIONS Opioid initiation post-surgical hospital admission leads to chronic use of opioids in a small percentage of the population. However, given the frequency at which surgical procedures occur, this means that a large number of people in the population may be affected. Post-discharge assessment and follow-up of at-risk patients is important, particularly where psychosocial elements such as anxiety and catastrophising are identified.
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Affiliation(s)
| | - Renly Lim
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia Division of Health Sciences, Adelaide, South Australia, Australia
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Ho E, Doherty M, Thomas R, Attia J, Oldmeadow C, Clapham M. Prescription of opioids to post-operative orthopaedic patients at time of discharge from hospital: a prospective observational study. Scand J Pain 2019; 18:253-259. [PMID: 29794303 DOI: 10.1515/sjpain-2017-0149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/30/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND AIMS Excessive opioid prescribing can lead to adverse consequences including stockpiling, misuse, dependency, diversion and mortality. Increased prescriptions to post-operative inpatients as part of their discharge planning may be a significant contributor. Primary aims included comparing the amount of opioids prescribed, consumed, left unused and their relationship with pain and functionality. METHODS A total of 132 consecutive patients who underwent elective orthopaedic surgery were prospectively audited. Daily oral morphine equivalent (DME) of opioids prescribed was compared with opioids consumed and amount left unused 7-10 days after discharge. For analysis, patients were split into three groups: total knee replacement (TKR), hand surgery (Hands), and miscellaneous (Misc). RESULTS The mean dose of opioid prescribed per patient was 108.5 mg DME. TKR consumed 33-35% more opioids than Misc (p=0.0283) and Hands (p=0.0975). Age was a significant independent factor for opioid consumption in the 50th and 75th percentiles of Hands (p≤0.05). An average of 36 mg DME per patient was left unused with Hands having the highest median DME (37 mg) unused. In the total cohort, 26% of patients were discharged with more DME than their last 24 h as an inpatient and had at least 50% of their tablets left unused at follow-up. CONCLUSIONS Over-prescription of opioids occurs at discharge which can increase the risk of harm. New intervention is needed to optimise prescribing practises. IMPLICATIONS Changes to prescribing habits and workplace culture are required to minimise unnecessary opioid prescribing but will be challenging to implement. A multi-layered approach of electronic prescribing, opioid stewardship and targeted educational awareness programmes is recommended.
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Affiliation(s)
- Edward Ho
- Department of Anaesthesia, John Hunter Hospital, Lookout Rd, New Lambton Heights, NSW, 2305, Australia, Phone: (+61) 4921 3000
| | - Matthew Doherty
- John Hunter Hospital, Lookout Rd, New Lambton Heights, NSW, 2305, Australia
| | - Robert Thomas
- Department of Anaesthesia, John Hunter Hospital, Lookout Rd, New Lambton Heights, NSW, 2305, Australia
| | - John Attia
- John Hunter Hospital, Lookout Rd, New Lambton Heights, NSW, 2305, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,University of Newcastle, Callaghan NSW, 2308, Australia
| | | | - Matthew Clapham
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
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Tully A, Anderson L, Adams W, Mosier MJ. Opioid creep in burn center discharge regimens: Doubled amounts and complexity of narcotic prescriptions over seven years. Burns 2019; 45:328-334. [DOI: 10.1016/j.burns.2018.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 07/01/2018] [Accepted: 08/07/2018] [Indexed: 11/26/2022]
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Who Are Dispensed the Bulk Amount of Prescription Opioids? J Clin Med 2019; 8:jcm8030293. [PMID: 30832231 PMCID: PMC6462899 DOI: 10.3390/jcm8030293] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 01/01/2023] Open
Abstract
Background: Excessive and non-medical use of prescription opioids is a public health crisis in many settings. This study examined the distribution of user types based on duration of use, trends in and associated factors of dispensing of prescription opioids in New South Wales and Victoria, Australia. Methods: 10% sample of unit-record data of four-year dispensing of prescription opioids was analysed. Quantities dispensed were computed in defined daily dose (DDD). Multilevel models examined factors associated with the duration of dispensing and the quantity dispensed in local government areas. Results: Overall, 53% were single-quarter, 37.3% medium-episodic (dispensed 2–6 quarters), 5% long-episodic (dispensed 7–11 quarters) and 5% were chronic users (dispensed 12–14 quarters). More than 80% of opioids in terms of DDD/1000 people/day were dispensed to long-episodic and chronic users. Codeine and oxycodone were most popular items—both in terms of number of users and quantity dispensed. Duration of dispensing was significantly higher for women than men. Dispensing quantity and duration increased with increasing age and residence in relatively poor neighborhoods. Conclusions: Although only 5% were chronic users, almost 60% of opioids (in DDD/1000 people/day) were dispensed to them. Given that chronic use is linked to adverse health outcomes, and there is a progression toward chronic use, tailored interventions are required for each type of users.
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Zheng D, Narayan SW, Zoega H, Litchfield M, Buckley NA, Pearson SA, Schaffer AL. Anticipating the effects of restricting high-dose preparations of strong opioids in Australia: A population-based analysis to inform the current policy debate. Pharmacoepidemiol Drug Saf 2019; 28:521-527. [PMID: 30790376 DOI: 10.1002/pds.4755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/04/2018] [Accepted: 01/27/2019] [Indexed: 11/07/2022]
Abstract
PURPOSE Countries worldwide are developing a variety of strategies to combat the opioid epidemic, such as restricting access to high-strength opioid formulations. We aimed to examine the dispensing patterns of strong opioids by dose units (DUs), age, and sex. METHODS We used Australian population-level dispensing data from January 2003 to December 2015 and categorised strong opioids by DU: very low, low, moderate, and high, corresponding to total daily doses of less than or equal to 25, 26 to 50, 51 to 100, and greater than 100 morphine milligramme equivalents, respectively. We measured trends in strong opioid use as dispensings/1000 population/year and stratified dispensing in 2015 by patient age and sex. RESULTS From 2003 to 2015, strong opioid dispensing of very low, low, moderate, and high DU increased 6.7-, 6.2-, 2.2-, and 1.8-fold, respectively. The increase in very low and low DU dispensing was driven primarily by oxycodone (5, 10, and 15 mg tablets and capsules) and buprenorphine transdermal patches. In 2015, the number of dispensings/1000 population for very low, low, moderate, and high DU were 180.3, 77.0, 52.7, and 34.8, respectively. Females aged greater than or equal to 85 years had the highest opioid use, ranging from 157.1 dispensings/1000 population for high DU to 2104.5 dispensings/1000 population for very low DU. In contrast, the high DU dispensings in males aged 25 to 64 years exceeded their female counterparts by approximately 1.3-fold. CONCLUSION Relative to moderate and high DU strong opioids, dispensing of very low and low DU strong opioids increased dramatically during the study period in Australia. Future studies investigating opioids use and harms in elderly females and males between 25 to 64 years are warranted.
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Affiliation(s)
- Danni Zheng
- Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Sujita W Narayan
- Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Helga Zoega
- Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia.,Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Melisa Litchfield
- Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Nicholas A Buckley
- Discipline of Pharmacology, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Sallie-Anne Pearson
- Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia.,Menzies Centre for Health Policy, University of Sydney, Sydney, Australia
| | - Andrea L Schaffer
- Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
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Gilmartin-Thomas JFM, Bell JS, Liew D, Arnold CA, Buchbinder R, Chapman C, Cicuttini F, Dobbin M, Gibson SJ, Giummarra MJ, Gowan J, Katz B, Lubman DI, McCrone M, Pilgrim J, Synnot A, van Dyk E, Workman B, McNeil J. Chronic pain medication management of older populations: Key points from a national conference and innovative opportunities for pharmacy practice. Res Social Adm Pharm 2019; 15:207-213. [DOI: 10.1016/j.sapharm.2018.03.060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 03/01/2018] [Accepted: 03/18/2018] [Indexed: 01/20/2023]
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Stevens J, Trimboli A, Samios P, Steele N, Welch S, Thompson P, Halvorsen C, Kerr S. A sustainable method to reduce postoperative oxycodone discharge prescribing in a metropolitan tertiary referral hospital. Anaesthesia 2019; 74:292-299. [DOI: 10.1111/anae.14570] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2018] [Indexed: 11/28/2022]
Affiliation(s)
- J. Stevens
- Brian Dwyer Department of Anaesthetics; St Vincent's Public Hospital; Darlinghurst NSW Australia
| | - A. Trimboli
- Prince of Wales Hospital; Sydney NSW Australia
| | - P. Samios
- Justice Health and Forensic Mental Health Network; Sydney NSW Australia
| | - N. Steele
- Brian Dwyer Department of Anaesthetics; St Vincent's Public Hospital; Darlinghurst NSW Australia
| | - S. Welch
- Brian Dwyer Department of Anaesthetics; St Vincent's Public Hospital; Darlinghurst NSW Australia
| | - P. Thompson
- Brian Dwyer Department of Anaesthetics; St Vincent's Public Hospital; Darlinghurst NSW Australia
| | - C. Halvorsen
- Royal Australian Air Force Base; Townsville Health Centre; Currajong QLD Australia
| | - S. Kerr
- Faculty of Medicine; Chulalongkorn University; Bangkok Thailand
- Biostatistics Centre, Research Affairs, Faculty of Medicine, The Kirby Institute; University of New South Wales; Sydney NSW Australia
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Lalic S, Ilomäki J, Bell JS, Korhonen MJ, Gisev N. Prevalence and incidence of prescription opioid analgesic use in Australia. Br J Clin Pharmacol 2019; 85:202-215. [PMID: 30338545 PMCID: PMC6303244 DOI: 10.1111/bcp.13792] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/03/2018] [Accepted: 10/05/2018] [Indexed: 12/30/2022] Open
Abstract
AIMS The aims of the current study were to determine the prevalence and incidence of prescription opioid analgesic use in Australia and compare the characteristics of people with and without cancer initiating prescription opioid analgesics. METHODS A retrospective population-based study was conducted using the random 10% sample of adults who were dispensed prescription opioid analgesics in Australia between July 2013 and June 2017 through the Pharmaceutical Benefits Scheme. Poisson regression was used to calculate rate ratios (RR) for opioid prevalence and incidence. The characteristics of people initiating opioids, including type of opioid initiated, total oral morphine equivalents dispensed, prescriber speciality, medical comorbidities, and past analgesic and benzodiazepine use, were compared for people with and without cancer. RESULTS Opioid prevalence increased {RR = 1.006 [95% confidence interval (CI) 1.004, 1.008]}, while incidence decreased [RR = 0.977 (95% CI 0.975,0.979)] from 2013/2014 to 2016/2017. There were between 287 677 and 307 772 prevalent users each year. In total, 769 334 adults initiated opioids between 2013/2014 and 2016/2017, and half of these initiations were by general practitioners. Initiation with a strong opioid occurred in 55.8% of those with cancer and 28.2% of those without cancer. CONCLUSION Rates of opioid use have remained high since 2013, with approximately 3 million adults using opioids and over 1.9 million adults initiating opioids each year. Between 2013 and 2017, opioid prevalence has slightly increased but incidence has decreased. People without cancer account for the majority of opioid use and are more likely to be initiated on short-acting and weak opioids. Initiation of strong opioids has increased over time, reinforcing concerns about increased use and the harms associated with strong opioids in the community.
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Affiliation(s)
- Samanta Lalic
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical, SciencesMonash UniversityMelbourneVICAustralia
- Pharmacy DepartmentAustin HealthMelbourneVICAustralia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical, SciencesMonash UniversityMelbourneVICAustralia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | - J. Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical, SciencesMonash UniversityMelbourneVICAustralia
- Department of Epidemiology and Preventive MedicineMonash UniversityMelbourneVICAustralia
- School of Pharmacy and Medical SciencesUniversity of South AustraliaAdelaideSAAustralia
| | - Maarit Jaana Korhonen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical, SciencesMonash UniversityMelbourneVICAustralia
- Institute of BiomedicineUniversity of TurkuTurkuFinland
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW SydneySydneyNSWAustralia
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Gisev N, Pearson SA, Dobbins T, Currow DC, Blyth F, Larney S, Dunlop A, Mattick RP, Wilson A, Degenhardt L. Combating escalating harms associated with pharmaceutical opioid use in Australia: the POPPY II study protocol. BMJ Open 2018; 8:e025840. [PMID: 30518593 PMCID: PMC6286479 DOI: 10.1136/bmjopen-2018-025840] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 09/26/2018] [Accepted: 09/26/2018] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Opioid prescribing has increased 15-fold in Australia in the past two decades, alongside increases in a range of opioid-related harms such as opioid dependence and overdose. However, despite concerns about increasing opioid use, extramedical use and harms, there is a lack of population-level evidence about the drivers of long-term prescribed opioid use, dependence, overdose and other harms. METHODS AND ANALYSIS We will form a cohort of all adult residents in New South Wales (NSW), Australia, who initiated prescribed opioids from 2002 using Pharmaceutical Benefits Scheme dispensing records. This cohort will be linked to a wide range of other datasets containing information on sociodemographic and clinical characteristics, health service use and adverse outcomes (eg, opioid dependence and non-fatal and fatal overdose). Analyses will initially examine patterns and predictors of prescribed opioid use and then apply regression and survival analysis to quantify the risks and risk factors of adverse outcomes associated with prescribed opioid use. ETHICS AND DISSEMINATION This study has received full ethical approval from the Australian Institute of Health and Welfare Ethics Committee, the NSW Population and Health Services Research Committee and the ACT Health Human Research Ethics Committee. This will be the largest postmarketing surveillance study of prescribed opioids undertaken in Australia, linking exposure and outcomes and examining risk factors for adverse outcomes of prescribed opioids. As such, this work has important translational promise, with direct relevance to regulatory authorities and agencies worldwide. Project findings will be disseminated at scientific conferences and in peer-reviewed journals. We will also conduct targeted dissemination with policy makers, professional bodies and peak bodies in the pain, medicine and addiction fields through stakeholder workshops and advisory groups. Results will be reported in accordance with the REporting of studies Conducted using Observational Routinely collected Data (RECORD) Statement.
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Affiliation(s)
- Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Timothy Dobbins
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - David C Currow
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Fiona Blyth
- Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Adrian Dunlop
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, Newcastle, New South Wales, Australia
- Drug and Alcohol Clinical Services, Hunter New England, Newcastle, New South Wales, Australia
| | - Richard P Mattick
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Andrew Wilson
- Menzies Centre for Health Policy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
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Schwartz GD, Harding AM, Donaldson SR, Greene SL. Modifying emergency department electronic prescribing for outpatient opioid analgesia. Emerg Med Australas 2018; 31:417-422. [PMID: 30508874 DOI: 10.1111/1742-6723.13192] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/23/2018] [Accepted: 09/25/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to examine how changing the electronic ordering sequences for opioid analgesics affected ED outpatient prescribing, and subsequent unused opioid tablets remaining in the community available for diversion. METHODS A descriptive before and after study in adult patients prescribed an opioid analgesic by an ED prescriber for use in the outpatient setting. The hospital electronic prescribing system (FirstNet™) was modified to include smaller quantities of opioid analgesics for discharge. The change in quantity of opioid prescribed and change in quantity of opioid analgesic remaining in the community at follow up was measured pre- and post-intervention using a structured telephone interview. RESULTS Pre- and post-intervention, 102 and 106 patients were interviewed, respectively. Percentage of prescriptions for oxycodone quantity five tablets increased from 3% to 32% and for quantity 20 tablets fell from 40% to 24% post-intervention. For paracetamol with codeine, prescriptions for quantity 10 tablets increased from 2% to 24% while for quantity 20 tablets fell from 98% to 76%. Mean number of tablets prescribed per patient fell from 13.8 (SD = 5.1) to 10.8 (SD = 5.6) for oxycodone and from 19.8 (SD = 1.5) to 17.6 (SD = 4.2) for paracetamol with codeine. Fifty-eight percent of patients in both pre- and post-intervention groups used half or less of the medication prescribed. CONCLUSION Modification of an ED electronic prescribing system reduced overall quantities of opioid analgesics supplied and subsequently stored in the community but did not change the proportion of patients (>50%) who reported using half or less of their prescribed opioid medication.
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Affiliation(s)
- Grace D Schwartz
- Emergency Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Andrew M Harding
- Emergency Medicine, Austin Health, Melbourne, Victoria, Australia.,Pharmacy Department, Austin Health, Melbourne, Victoria, Australia
| | - Síne R Donaldson
- Emergency Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Shaun L Greene
- Emergency Medicine, Austin Health, Melbourne, Victoria, Australia.,Clinical Toxicology Service, Austin Hospital, Melbourne, Victoria, Australia
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Islam MM, Wollersheim D. Variation in Prescription Opioid Dispensing across Neighborhoods of Diverse Socioeconomic Disadvantages in Victoria, Australia. Pharmaceuticals (Basel) 2018; 11:ph11040116. [PMID: 30388736 PMCID: PMC6315505 DOI: 10.3390/ph11040116] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/12/2018] [Accepted: 10/24/2018] [Indexed: 01/10/2023] Open
Abstract
The study examined the relationship between dispensing patterns of prescription opioids, neighborhood-disadvantage-index, and standardized doses dispensed. Three-year’s dispensing data drawn from 80 local government areas (LGAs) within Victoria, Australia’s second most populous state, was analyzed. Quantities dispensed in defined daily dose (DDD)/1000-people/day were computed for LGAs of low, moderate, high, and very high socio-economic disadvantage. LGAs with various levels of dispensing, and neighborhood disadvantage were identified and mapped. A multivariable regression model examined the effect of neighborhood level disadvantage and identified other factors that are associated with standardized doses dispensed. More women were dispensed opioids than men. Dispensing increased with increasing age. Most of the LGAs with relatively high dispensing were socioeconomically disadvantaged and located outside the major cities. Dispensing gradually increased from low disadvantage to very high disadvantage areas. Dispensing of standardized doses were consistently higher in rural areas than in urban areas. Neighborhood level disadvantage, age, sex, and urbanization were significant factors in the standardized doses dispensed. As inappropriate dispensing of opioids is a major public health problem, research should facilitate understanding of utilization in small areas to enable tailored public health programs. Nationwide and consistent introduction of real-time prescription drug-monitoring programs, and structural interventions to reduce the fundamental causes of socioeconomic disadvantage and isolation are recommended.
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Affiliation(s)
- M Mofizul Islam
- Department of Public Health, La Trobe University, Melbourne, Victoria 3086, Australia.
| | - Dennis Wollersheim
- Health Information Management, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria 3086, Australia.
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Namba RS, Paxton EW, Inacio MC. Opioid Prescribers to Total Joint Arthroplasty Patients Before and After Surgery: The Majority Are Not Orthopedists. J Arthroplasty 2018; 33:3118-3124.e3. [PMID: 29934272 DOI: 10.1016/j.arth.2018.05.034] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/16/2018] [Accepted: 05/22/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Improved narcotic pain management after total joint arthroplasty (TJA) is necessary to help battle the opioid epidemic. The goal of this study was to determine the sources of prescriptions prescribed to TJA patients. METHODS An evaluation of opioid use in patients undergoing primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) was performed between 2008 and 2012. Using a Total Joint Replacement Registry and pharmacy data, opioids dispensed to TJA patients were identified. The main outcome of interest was who prescribed opioids to patients in the year before and after surgery. RESULTS Primary care (pre-TKA 31% TKA, post-TKA 38%, pre-THA 34%, post-THA 40%) and internal medicine (27% pre-TKA, post-TKA 37%, pre-THA 32%, post-THA 40%) were the highest prescribers in the year before, and after, TJA. For TKA patients, orthopedists prescribed 9% of the opioids in the year before surgery, 47% in days 1-90 after surgery, and 14% in days 271-360. Similarly, in THA patients, orthopedists prescribed 14% of the opioids in the year before surgery, 40% in days 1-90 after surgery, and 14% in days 271-360. CONCLUSION Patients receive opioid prescriptions from multiple physician types before, and after, TJA. The majority of preoperative, and late postoperative, narcotics were not provided by their surgeons. Orthopedic surgeons may not even know that their TJA patients continue to receive opioids. Coordination of opioid care with health-care providers and greater communication with patients on narcotic use expectations should be promoted.
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Affiliation(s)
- Robert S Namba
- Southern California Permanente Medical Group, Irvine, California
| | - Elizabeth W Paxton
- Kaiser Permanente, Surgical Outcomes and Analysis, San Diego, California
| | - Maria C Inacio
- Kaiser Permanente, Surgical Outcomes and Analysis, San Diego, California; South Australian Health and Medical Research Institute, Adelaide, Australia
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Larance B, Gisev N, Cama E, Nelson EC, Darke S, Larney S, Degenhardt L. Predictors of transitions across stages of heroin use and dependence prior to treatment-seeking among people in treatment for opioid dependence. Drug Alcohol Depend 2018; 191:145-151. [PMID: 30107320 PMCID: PMC6698181 DOI: 10.1016/j.drugalcdep.2018.03.056] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 03/30/2018] [Accepted: 03/31/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND AIMS Little is known about transition pathways among heroin users prior to treatment. This study examined the demographic and clinical predictors of transition speed from heroin use, to dependence, to first treatment episode. METHODS 1149 heroin-dependent participants recruited from opioid agonist treatment clinics in Sydney, Australia, underwent a structured interview. Age of onset (AOO) was collected for heroin use, dependence and treatment-seeking, childhood maltreatment, psychiatric history and other substance dependence. Discrete-time survival analyses modelled years from onset of use to dependence, and from dependence to treatment-seeking, including demographic and clinical covariates. FINDINGS Median AOO for first heroin use, dependence and treatment-seeking was 18 years (inter-quartile range, or IQR = 6), 21 years (IQR = 7), and 24 years (IQR = 10) respectively. In adjusted models, younger birth cohorts (vs. born <1960), greater childhood maltreatment and later AAO of first heroin use were associated with more rapid transitions from heroin use to dependence. Living independently, parental violence, and alcohol dependence were associated with slower transitions. Earlier treatment-seeking was associated with younger birth cohorts, having dependent children and later AOO of dependence. Delayed treatment-seeking was associated with <10 years school education, living independently, depression and alcohol dependence. CONCLUSIONS In this treatment sample, onset of heroin use occurred during late adolescence, suggesting the need for targeted interventions in mid-adolescence. Transitions to heroin dependence, then treatment-seeking, occurred during early adulthood. Rapid transitions from use to dependence were associated with younger birth cohorts, greater exposure to childhood maltreatment, and later onset of use.
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Affiliation(s)
- Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King Street Randwick, Sydney, NSW, 2052, Australia.
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King Street Randwick, Sydney, NSW, 2052, Australia
| | - Elena Cama
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King Street Randwick, Sydney, NSW, 2052, Australia
| | - Elliot C Nelson
- Washington University, School of Medicine, Department of Psychiatry, 660 South Euclid Avenue, Campus Box 8134, St. Louis, MO, 63110, USA
| | - Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King Street Randwick, Sydney, NSW, 2052, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King Street Randwick, Sydney, NSW, 2052, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King Street Randwick, Sydney, NSW, 2052, Australia
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