Transition to high‐dose or strong opioids: a population‐based study of people initiating opioids in Australia

Abstract

Background and aims Strong and high-dose opioids are associated with opioid overdose and death. The objective of this study was to determine the rate and predictors of transitioning to high-dose or strong opioids among people initiating opioids. Design Retrospective cohort study. Setting Australia. Participants People initiating opioid analgesics from July 2013 to January 2018 were identified from a random 10% sample of Australia's Pharmaceutical Benefits Scheme eligible population. Measurements Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for the predictors of escalating to ≥ 50 mg oral morphine equivalents (OMEs)/day (cohort 1); ≥ 90 mg OMEs/day (cohort 2) and transitioning from weak opioids to strong opioids (cohort 3) over 12 months of follow-up. Predictors included age, sex, number of comorbidities, history of depression, prior treatment for cancer and selected other medication use. Findings In total, 861 691 people initiated opioids at average doses < 50 mg OMEs/day (cohort 1), 874 401 at < 90 mg OMEs/day (cohort 2) and 603 884 initiated weak opioids (cohort 3). Overall, 1.4% of people escalated to doses ≥ 50 mg OMEs/day, 0.8% to doses ≥ 90 mg OMEs/day and 7.3% transitioned to strong opioids. The strongest predictors of transitioning included prior treatment for cancer [cohort 1: HR = 3.19, 95% CI = 3.00-3.40; cohort 2: HR = 4.19, 95% CI = 3.90-4.51; cohort 3: HR = 2.07, 95% CI = 1.95-2.18] and age ≥ 75 years (cohort 1: HR = 3.04, 95% CI = 2.73-3.38; cohort 2: HR = 2.51, 95% CI = 2.17-2.89; cohort 3: HR = 1.88, 95% CI = 1.80-1.96). Females transitioned to high doses and strong opioids less rapidly than males (cohort 1: HR = 0.79, 95% CI = 0.76-0.82; cohort 2: HR = 0.70, 95% CI = 0.66-0.73; cohort 3: HR = 0.95, 95% CI = 0.93-0.96). Conclusions In Australia, more than one in every 13 people initiating weak opioids transition to strong opioids. By extrapolation, more than 26 000 Australian adults initiating opioids escalate to high doses each year. People with cancer treatment history, older people and males transition to strong and high-dose opioids more rapidly than others.

Five-Year Trajectories of Prescription Opioid Use

“…The sustained use, low increasing to moderate use, and moderate decreasing to low use trajectory groups appeared to include people with complex needs. The characteristics observed in these groups are consistent with those in previous work and resemble the factors associated with dose escalation and transition to stronger opioids . These characteristics included older age, comorbid depression or psychotic illness, and use of psychotropics and nonopioid analgesics .…”

Tau protein plays a role in the mechanism of cognitive disorders induced by anesthetic drugs

“…Among the surgical patients receiving opioid treatment, 3-7% became chronic opioid users (Nobel et al, 2019). Addiction and drug dependence on opioids are potential risks associated with their use (Lalic et al, 2020).…”

Patterns of filled prescriptions and the association with risk of drug‐induced death. A population‐based nested case‐control register study

“…18 Sedatives like benzodiazepines and benzodiazepinerelated drugs may interact with opioids and increase the risk of death. 7,[19][20][21][22] Concomitant use of OA and sedating antipsychotics have also been associated with a higher risk of overdose than concomitant use of OA and non-sedating antipsychotics. 23 In addition, concomitant use of the OA oxycodone and potent CYP2D6-inhibiting selective serotonin reuptake inhibitors (SSRIs) may increase the risk of opioid overdose compared to concomitant use of oxycodone and other SSRIs, an association based on an effect on oxycodone metabolism.…”