Using opioids in general practice for chronic non‐cancer pain: an overview of current evidence

Currow, David C.; Phillips, Jane; Clark, Katherine

doi:10.5694/mja16.00618

Cited by 6 publications

(4 citation statements)

References 41 publications

(54 reference statements)

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“…The risk of harms from these medications (including the harms of starting new long-term opioid therapy and the harms of continuing therapy instead of offering alternative therapies with better evidence of efficacy) must be balanced with the potential harms of nonconsensual discontinuation of opioids for long-term users, including increased pain, risk of suicide and risk of transition to the toxic illicit drug supply. [19][20][21][22] Stimulants, overwhelmingly nonprescribed, were relevant to 71% of the illicit drug deaths in our sample, in keeping with the rise of unprescribed stimulant use across North America 12 and increasing methamphetamine use in BC. 23 The relation between stimulant use, opioid and other substance use, and risk of death is complex.…”

Section: Discussionmentioning

confidence: 58%

Toxicology and prescribed medication histories among people experiencing fatal illicit drug overdose in British Columbia, Canada

Crabtree

Lostchuck

Chong

et al. 2020

CMAJ

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Section: Discussionmentioning

confidence: 58%

Toxicology and prescribed medication histories among people experiencing fatal illicit drug overdose in British Columbia, Canada

Crabtree

Lostchuck

Chong

et al. 2020

CMAJ

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“…In the United States, supply-side policies, including the implementation of PDMPs, were identified as a key precipitating factor for the current opioid crisis, including driving harms related to illicit drug use [8]. In Australia, most opioids are prescribed in primary care settings, and most opioid mortality is still attributed to prescription opioid use [9][10][11]. Yet, we have little understanding of how similar supply-side interventions are influencing opioid prescribing in primary care and whether changes in prescribing lead to their intended outcome of reducing harms.…”

Section: Introductionmentioning

confidence: 99%

Determining the Impact of Opioid Policy on Substance Use and Mental Health–Related Harms: Protocol for a Data Linkage Study

Xia,

Picco,

Lalic

et al. 2023

JMIR Res Protoc

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Background Increasing harms related to prescription opioids over the past decade have led to the introduction of a range of key national and state policy initiatives across Australia. These include introducing a mandatory real-time prescription drug–monitoring program in the state of Victoria from April 2020 and a series of changes to subsidies for opioids on the Pharmaceutical Benefit Scheme from June 2020. Together, these changes aim to influence opioid supply and reduce harms related to prescription opioids, yet few studies have specifically explored how these policies have influenced opioid prescribing and related harms in Australia. Objective The aim of this study is to examine the impact of a range of opioid-related policies on hospital admissions and emergency department (ED) presentations in Victoria, Australia. In particular, the study aims to understand the effect of various opioid policies and opioid-prescribing changes on (1) the number and rates of ED presentations and hospital admissions attributed to substance use (ie, opioid and nonopioid related) or mental ill-health (eg, suicide, self-harm, anxiety, and depression), (2) the association between differing opioid dose trajectories and the likelihood of ED presentations and hospital admissions related to substance use and mental ill-health, and (3) whether changes in an individual’s opioid prescribing change the risk related to ED presentations and hospital admissions related to substance use and mental ill-health. Methods We will conduct a population-level linked data study. General practice health records obtained from the Population Level Analysis and Reporting platform are linked with person-level data from 3 large hospital networks in Victoria, Australia. Interrupted time series analysis will be used to examine the impact of opioid policies on a range of harms, including the rates of presentations related to substance use (opioid and nonopioid) and mental ill-health among the primary care cohort. Group-based trajectory modeling and a case-crossover design will be used to further explore the impact of changes in opioid dosage and other covariates on opioid and nonopioid poisonings and mental ill-health–related presentations at the patient level. Results Given that this paper serves as a protocol, there are currently no results available. The deidentified primary health data were sourced from electronic medical records of approximately 4,717,000 patients from 542 consenting general practices over a 6-year period (2017-2022). The submission of results for publication is planned for early 2024. Conclusions This study will add to the limited evidence base to help understand the impact of opioid policies in Australia, including whether intended or unintended outcomes are occurring as a result. Trial Registration EU PAS Register EUPAS104005; https://www.encepp.eu/encepp/viewResource.htm?id=104006 International Registered Report Identifier (IRRID) DERR1-10.2196/51825

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“…Safety data of long‐term opioid therapy have been poorly studied in chronic non‐cancer pain (CNCP) and common ADRs include gastrointestinal symptoms as nausea, vomiting and constipation; dependency and dosage tolerance; endocrine disorders; or opioid‐induced hyperalgesia . Thus, spontaneous reporting systems to collect suspected ADRs have become the most important component for pharmacovigilance monitoring to improve patient's health status and reduce health system resources utilisation .…”

Section: Introductionmentioning

confidence: 99%

Health benefits of an adverse events reporting system for chronic pain patients using long‐term opioids

Planelles

Margarit

Ajo

et al. 2018

Acta Anaesthesiol Scand

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Using opioids in general practice for chronic non‐cancer pain: an overview of current evidence

Cited by 6 publications

References 41 publications

Toxicology and prescribed medication histories among people experiencing fatal illicit drug overdose in British Columbia, Canada

Toxicology and prescribed medication histories among people experiencing fatal illicit drug overdose in British Columbia, Canada

Determining the Impact of Opioid Policy on Substance Use and Mental Health–Related Harms: Protocol for a Data Linkage Study

Health benefits of an adverse events reporting system for chronic pain patients using long‐term opioids

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