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Genel F, Harris IA, Pavlovic N, Lewin A, Mittal R, Huang AY, Penm J, Patanwala AE, Brady B, Adie S, Naylor JM. Does preoperative opioid use predict outcomes to 6 months following primary unilateral knee or hip arthroplasty for osteoarthritis? A data-linked retrospective study. ARTHROPLASTY 2024; 6:11. [PMID: 38438888 PMCID: PMC10913630 DOI: 10.1186/s42836-024-00234-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/03/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Few Australian studies have examined the incidence of prescribed opioid use prior to primary total knee or total hip arthroplasty (TKA, THA) and whether it predicts post-surgery outcomes. A recent Australian study demonstrated that the prevalence of pre-arthroplasty opioid use was approximately 16%. In the United States, approximately 24% of people undergoing TKA or THA are chronic opioid users preoperatively. PURPOSE This study aimed to determine (i) the proportion of TKA and THA patients who use prescribed opioids regularly (daily) before surgery (i.e., opioid use reported between the time of waitlisting and any time up to 3 months before surgery), (ii) if opioid use before surgery predicts (a) complication/readmission rates to 6-months post-surgery, and (b) patient-reported outcomes to 6-months post-surgery. METHODS A retrospective cohort study of patients who underwent TKA or THA between January 2013 and June 2018 from two Australian public hospitals was undertaken utilizing linked individual patient-level data from two prospectively collected independent databases comprising approximately 3,500 and 9,500 people (database contained known opioid usage data within the 5-year time frame). Inclusion criteria included (i) primary diagnosis of osteoarthritis of the index joint, (ii) primary elective THA or TKA, and (iii) age ≥ 18 years. Exclusion criteria included (i) revision arthroplasty, (ii) non-elective arthroplasty, (iii) hip hemiarthroplasty, (iv) uni-compartmental knee arthroplasty, and (v) previous unilateral high tibial osteotomy. RESULTS Analysis was completed on 1,187 study participants (64% female, 69% TKA, mean (SD) age 67 [9.9]). 30% were using regular opioids preoperatively. Adjusted regression analyses controlling for multiple co-variates indicated no significant association between preoperative opioid use and complications/readmission rates or patient-reported outcomes to 6 months post-surgery. Model diagnostics produced poor discrimination for area under the curves and non-significant goodness of fit tests. Pre-arthroplasty opioid use was associated with lower health-related quality of life (EuroQol-Visual Analogue Scale) compared to non-opioid users undergoing primary THA (mean difference -5.04 [-9.87, -0.22], P = 0.04, Adjusted R2 = 0.06) CONCLUSION: In this study, 30% of patients were using prescribed opioids daily prior to primary TKA or THA. Pre-arthroplasty opioid use was not associated with postoperative adverse events or patient-reported pain, function, or global perceived improvement up to six months post-surgery.
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Affiliation(s)
- Furkan Genel
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, NSW, 2170, Australia.
- St. George and Sutherland Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2217, Australia.
| | - Ian A Harris
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, NSW, 2170, Australia
- Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, 2170, Australia
- South Western Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2170, Australia
| | - Natalie Pavlovic
- South Western Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2170, Australia
- Fairfield Hospital, South Western Sydney Local Health District, Sydney, NSW, 2176, Australia
| | - Adriane Lewin
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, NSW, 2170, Australia
- South Western Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2170, Australia
| | - Rajat Mittal
- South Western Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2170, Australia
| | - Andrew Y Huang
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Jonathan Penm
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2050, Australia
- Department of Pharmacy, Prince of Wales Hospital and Community Health Services, Randwick, NSW, 2031, Australia
| | - Asad E Patanwala
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2050, Australia
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
| | - Bernadette Brady
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2050, Australia
- School of Health Sciences, Western Sydney University, Sydney, NSW, 2751, Australia
| | - Sam Adie
- St. George and Sutherland Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2217, Australia
- St. George and Sutherland Centre for Clinical Orthopaedic Research, Kogarah, NSW, 2217, Australia
| | - Justine M Naylor
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, NSW, 2170, Australia
- South Western Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2170, Australia
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Picco L, Jung M, Cangadis-Douglass H, Lam T, Nielsen S. Identifying Prescription-Opioid-Related Risks Using Prescription Drug Monitoring Programs' Algorithms and Clinical Screening Tools. PHARMACY 2023; 11:164. [PMID: 37888509 PMCID: PMC10609676 DOI: 10.3390/pharmacy11050164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/02/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Pharmacists adopt various approaches to identifying prescription-opioid-related risks and harms, including prescription drug monitoring programs (PDMPs) and clinical screening tools. This study aims to compare 'at-risk' patients according to the published Australian PDMP algorithms with the validated Routine Opioid Outcome Monitoring (ROOM) clinical screening tool. METHODS Data were used from an implementation study amongst people who had been prescribed regular opioids. We examined the results from ROOM and the patients' dispensing history over the previous 90 days. A chi-squared test was used to examine the association between risk according to (i) a PDMP alert and a clinical risk per ROOM; (ii) a PDMP alert and positive screening for opioid use disorder; and (iii) a PDMP 'high-dose' alert (average of >100 mg OME/day in the past 90 days) and any ROOM-validated risk. RESULTS No significant associations were found between being 'at-risk' according to any of the PDMP alerts and clinical risk as identified via the ROOM tool (x2 = 0.094, p = 0.759). There was only minimal overlap between those identified as 'at-risk' via PDMP alerts and those meeting the clinical risk indicators; most patients who were 'at-risk' of clinical opioid-related risk factors were not identified as 'at-risk' based on PDMP alerts. CONCLUSIONS PDMP alerts were not predictive of clinical risk (as per the ROOM tool), as many people with well-established clinical risks would not receive a PDMP alert. Pharmacists should be aware that PDMPs are limited to identifying medication-related risks which are derived using algorithms; therefore, augmenting PDMP information with clinical screening tools can help create a more detailed narrative of patients' opioid-related risks.
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Affiliation(s)
- Louisa Picco
- Monash Addiction Research Centre, Peninsula Campus, Monash University, 47-49 Moorooduc Hwy Frankston, Victoria 3199, Australia; (M.J.); (H.C.-D.); (T.L.)
| | - Monica Jung
- Monash Addiction Research Centre, Peninsula Campus, Monash University, 47-49 Moorooduc Hwy Frankston, Victoria 3199, Australia; (M.J.); (H.C.-D.); (T.L.)
- Centre for Medicine Use and Safety (CMUS), Parkville Campus, Monash University, 381 Royal Parade Parkville, Victoria 3052, Australia
| | - Helena Cangadis-Douglass
- Monash Addiction Research Centre, Peninsula Campus, Monash University, 47-49 Moorooduc Hwy Frankston, Victoria 3199, Australia; (M.J.); (H.C.-D.); (T.L.)
- Centre for Medicine Use and Safety (CMUS), Parkville Campus, Monash University, 381 Royal Parade Parkville, Victoria 3052, Australia
| | - Tina Lam
- Monash Addiction Research Centre, Peninsula Campus, Monash University, 47-49 Moorooduc Hwy Frankston, Victoria 3199, Australia; (M.J.); (H.C.-D.); (T.L.)
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Peninsula Campus, Monash University, 47-49 Moorooduc Hwy Frankston, Victoria 3199, Australia; (M.J.); (H.C.-D.); (T.L.)
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Schaffer AL, Gisev N, Blyth FM, Buckley NA, Currow D, Dobbins TA, Wilson A, Degenhardt L, Pearson S. Opioid prescribing patterns among medical practitioners in New South Wales, Australia. Drug Alcohol Rev 2023; 42:1472-1481. [PMID: 37159416 PMCID: PMC10946566 DOI: 10.1111/dar.13675] [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: 08/31/2022] [Revised: 03/16/2023] [Accepted: 04/11/2023] [Indexed: 05/11/2023]
Abstract
INTRODUCTION Prescriber behaviour is important for understanding opioid use patterns. We described variations in practitioner-level opioid prescribing in New South Wales, Australia (2013-2018). METHODS We quantified opioid prescribing patterns among medical practitioners using population-level dispensing claims data, and used partitioning around medoids to identify clusters of practitioners who prescribe opioids based on prescribing patterns and patient characteristics identified from linked dispensing claims, hospitalisations and mortality data. RESULTS The number of opioid prescribers ranged from 20,179 in 2013 to 23,408 in 2018. The top 1% of practitioners prescribed 15% of all oral morphine equivalent (OME) milligrams dispensed annually, with a median of 1382 OME grams (interquartile range [IQR], 1234-1654) per practitioner; the bottom 50% prescribed 1% of OMEs dispensed, with a median of 0.9 OME grams (IQR 0.2-2.6). Based on 63.6% of practitioners with ≥10 patients filling opioid prescriptions in 2018, we identified four distinct practitioner clusters. The largest cluster prescribed multiple analgesic medicines for older patients (23.7% of practitioners) accounted for 76.7% of all OMEs dispensed and comprised 93.0% of the top 1% of practitioners by opioid volume dispensed. The cluster prescribing analgesics for younger patients with high rates of surgery (18.7% of practitioners) prescribed only 1.6% of OMEs. The remaining two clusters comprised 21.2% of prescribers and 20.9% of OMEs dispensed. DISCUSSION AND CONCLUSION We observed substantial variation in opioid prescribing among practitioners, clustered around four general patterns. We did not assess appropriateness but some prescribing patterns are concerning. Our findings provide insights for targeted interventions to curb potentially harmful practices.
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Affiliation(s)
- Andrea L. Schaffer
- School of Population HealthFaculty of Medicine and Health, UNSW SydneySydneyAustralia
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
| | - Fiona M. Blyth
- School of Public Health, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
| | - Nicholas A. Buckley
- Biomedical Informatics and Digital Health, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
| | - David Currow
- Faculty of Science, Medicine and HealthUniversity of WollongongWollongongAustralia
| | - Timothy A. Dobbins
- School of Population HealthFaculty of Medicine and Health, UNSW SydneySydneyAustralia
| | - Andrew Wilson
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW SydneySydneyAustralia
| | - Sallie‐Anne Pearson
- School of Population HealthFaculty of Medicine and Health, UNSW SydneySydneyAustralia
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
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McNeilage AG, Ashton-James CE, Scholz B. "We were all looking for the magic pill": A qualitative study of patient experiences using gabapentinoids for chronic pain. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 119:104112. [PMID: 37453375 DOI: 10.1016/j.drugpo.2023.104112] [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: 02/13/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Gabapentinoid medications are increasingly being used in chronic pain management, yet very little is known about the experiences of those using them. The aim of this study was to address this gap in the literature by qualitatively exploring the lived experiences of patients using gabapentinoids for chronic pain. METHODS Semi-structured interviews were conducted with 12 adults prescribed a gabapentinoid medication - either pregabalin or gabapentin - for chronic pain in Australia. Interviews were conducted in May 2022 via telephone or online video chat. Audio recordings of the interviews were transcribed verbatim, and data were analysed using reflexive thematic analysis. The Medication Adherence Model was used as a framework for synthesising the data and organising themes. RESULTS For participants in this study, the initial decision to use gabapentinoids for chronic pain was driven by a level of desperation for pain relief, a perceived lack of pain management alternatives, and a belief that the medication was safer and easier to access than opioids. However, once using gabapentinoids, experiences varied considerably with some viewing the medication as effective and safe, and others viewing it as useless or harmful. Some participants expressed concern that they were not adequately informed by their prescribers about the risks of gabapentinoid use. CONCLUSION These findings emphasise the importance of patient-provider communication and taking a patient-centred approach to gabapentinoid prescribing and de-prescribing. Future qualitative research in this area should involve primary care providers to gain a better understanding of factors driving increased gabapentinoid prescribing in chronic pain management as well as barriers to patient education.
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Affiliation(s)
- Amy G McNeilage
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia; Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Claire E Ashton-James
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Brett Scholz
- School of Medicine and Psychology, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
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Zhang NM, Daly D, Terblanche M, Joshi S, Tacey M, Vesty G, Zheng Z. Doctors' and Nurses' Attitudes of Acupuncture and Acupressure use in Perioperative Care: An Australian National Survey. Pain Manag Nurs 2022; 23:800-810. [PMID: 36153218 DOI: 10.1016/j.pmn.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 08/07/2022] [Accepted: 08/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Acupuncture and acupressure are not being systematically used in the management of postoperative nausea and vomiting and pain, despite being included in the guidelines. AIM To examine the beliefs, attitudes, and knowledge of Australian nurses/midwives and doctors toward the perioperative use of AA for the management of postoperative nausea and vomiting and pain; to explore the barriers and enablers influencing acupuncture and acupressure integration into hospital setting. METHODS A mixed-mode approach was undertaken for data collection. An online approach was used to recruit respondents from Australian College of Perioperative Nurses. Three hospitals from three different Australian states were selected via convenience sampling. RESULTS A total of 421 usable surveys were included in data analysis. The respondents comprised 14.3% doctors and 72.9% nurses/midwives. Overall, 69.4% were female, 85% were trained in Australia with 35% and 51.4% having knowledge or personal exposure to AA in general respectively. Over 60% of the respondents agreed AA should be routinely integrated into perioperative care, and over 80% would recommend AA to their patients if it was provided at their hospital, and, 75% would be willing to receive further education. The three main reported barriers included: perceived lack of scientific evidence (80.9%), unavailability of credentialed provider (77.2%) and lack of reimbursement (60.4%). CONCLUSIONS Positive attitudes are reported by Australian doctors and nurses toward AA. This is despite of low levels of knowledge or personal exposure to AA. Further studies are required to explore the implementation of barriers and address respondent calls for further education.
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Affiliation(s)
- Nancy Ming Zhang
- School of Health and Biomedical Science, RMIT University, Bundoora, Melbourne, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Australia
| | - David Daly
- Department of Anaesthesia and Perioperative Medicine, The Alfred Hospital, Melbourne, Australia
| | - Morne Terblanche
- Department of Anaesthesia and Perioperative Medicine, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Sumati Joshi
- Operating Theatre, Shoalhaven District Memorial Hospital, Nowra, New South Wales, Australia
| | - Mark Tacey
- Northern Health, Epping, Victoria, Australia; School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Gillian Vesty
- School of Accounting, RMIT University, Melbourne, Australia
| | - Zhen Zheng
- School of Health and Biomedical Science, RMIT University, Bundoora, Melbourne, Australia.
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Trends in opioid analgesic utilisation among people with a history of opioid dependence. Drug Alcohol Depend 2022; 238:109548. [PMID: 35841733 DOI: 10.1016/j.drugalcdep.2022.109548] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/23/2022] [Accepted: 06/27/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND We aimed to characterise opioid analgesic utilisation over a 16-year period among a cohort of people with a history of opioid dependence, comparing rates of use in and out of opioid agonist treatment (OAT). METHODS Retrospective cohort study in New South Wales, Australia, including 28,891 people with documented opioid dependence initiating opioid analgesics between July 2003 and December 2018. Linked administrative records provided data on prescription dispensings, sociodemographics, clinical characteristics, and OAT. Generalised estimating equation models estimated the incidence and adjusted incidence rate ratios (IRR) comparing periods in and out of OAT for the number of opioid analgesic dispensings (overall, for strong opioids, and the most commonly dispensed opioid types) and the amount dispensed in oral morphine equivalent milligrams (OME). RESULTS At initiation, 43.7% of the cohort were enrolled in OAT. The most commonly initiated opioid was codeine (including combinations with paracetamol; 67.8%), and 49.6% of the cohort were dispensed a psychotropic medicine in the previous 90 days. Incidence of all opioid analgesic dispensings was higher during periods out of OAT compared to in OAT (5.8 v. 2.3 dispensings per person-year; IRR 0.39, 95% CI 0.38, 0.41), with findings similar when stratified by type. Being in OAT was associated with a lower OME amount dispensed compared to out of OAT (-57.7%, 95% CI-58.8, -56.7). CONCLUSIONS People with opioid dependence had high rates of recent psychotropic medicine utilisation and current OAT enrolment at the time of opioid analgesic initiation. OAT was associated with a significant reduction in opioid analgesic dispensing.
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Chiappini S, Vickers-Smith R, Guirguis A, Corkery JM, Martinotti G, Harris DR, Schifano F. Pharmacovigilance Signals of the Opioid Epidemic over 10 Years: Data Mining Methods in the Analysis of Pharmacovigilance Datasets Collecting Adverse Drug Reactions (ADRs) Reported to EudraVigilance (EV) and the FDA Adverse Event Reporting System (FAERS). Pharmaceuticals (Basel) 2022; 15:ph15060675. [PMID: 35745593 PMCID: PMC9231103 DOI: 10.3390/ph15060675] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/21/2022] [Accepted: 05/24/2022] [Indexed: 01/14/2023] Open
Abstract
In the past twenty years, the consumption of opioid medications has reached significant proportions, leading to a rise in drug misuse and abuse and increased opioid dependence and related fatalities. Thus, the purpose of this study was to determine whether there are pharmacovigilance signals of abuse, misuse, and dependence and their nature for the following prescription opioids: codeine, dihydrocodeine, fentanyl, oxycodone, pentazocine, and tramadol. Both the pharmacovigilance datasets EudraVigilance (EV) and the FDA Adverse Events Reporting System (FAERS) were analyzed to identify and describe possible misuse-/abuse-/dependence-related issues. A descriptive analysis of the selected Adverse Drug Reactions (ADRs) was performed, and pharmacovigilance signal measures (i.e., reporting odds ratio, proportional reporting ratio, information component, and empirical Bayesian geometric mean) were computed for preferred terms (PTs) of abuse, misuse, dependence, and withdrawal, as well as PTs eventually related to them (e.g., aggression). From 2003 to 2018, there was an increase in ADR reports for the selected opioids in both datasets. Overall, 16,506 and 130,293 individual ADRs for the selected opioids were submitted to EV and FAERS, respectively. Compared with other opioids, abuse concerns were mostly recorded in relation to fentanyl and oxycodone, while tramadol and oxycodone were more strongly associated with drug dependence and withdrawal. Benzodiazepines, antidepressants, other opioids, antihistamines, recreational drugs (e.g., cocaine and alcohol), and several new psychoactive substances, including mitragynine and cathinones, were the most commonly reported concomitant drugs. ADRs reports in pharmacovigilance databases confirmed the availability of data on the abuse and dependence of prescription opioids and should be considered a resource for monitoring and preventing such issues. Psychiatrists and clinicians prescribing opioids should be aware of their misuse and dependence liability and effects that may accompany their use, especially together with concomitant drugs.
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Affiliation(s)
- Stefania Chiappini
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9EU, UK; (S.C.); (J.M.C.); (G.M.); (F.S.)
| | - Rachel Vickers-Smith
- Department of Epidemiology, University of Kentucky College of Public Health, 111 Washington Avenue, Lexington, KY 40536, USA
- Correspondence:
| | - Amira Guirguis
- Department of Pharmacy, Swansea University Medical School, The Grove, Swansea University, Swansea, Wales SA2 8PP, UK;
| | - John M. Corkery
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9EU, UK; (S.C.); (J.M.C.); (G.M.); (F.S.)
| | - Giovanni Martinotti
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9EU, UK; (S.C.); (J.M.C.); (G.M.); (F.S.)
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio, 66100 Chieti-Pescara, Italy
| | - Daniel R. Harris
- Institute for Pharmaceutical Outcomes and Policy, University of Kentucky College of Pharmacy, 289 South Limestone Street, Lexington, KY 40536, USA;
- Center for Clinical and Translational Sciences, University of Kentucky, 800 Rose Street, Lexington, KY 40506, USA
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9EU, UK; (S.C.); (J.M.C.); (G.M.); (F.S.)
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A pharmacist-led intervention to improve the management of opioids in a general practice: a qualitative evaluation of participant interviews. Int J Clin Pharm 2021; 44:235-246. [PMID: 34751891 DOI: 10.1007/s11096-021-01340-0] [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: 07/27/2021] [Accepted: 10/17/2021] [Indexed: 10/19/2022]
Abstract
Background Opioid prescribing has escalated, particularly long-term in chronic noncancer pain. Innovative models of care have been recommended to augment regulatory and harm-minimisation strategies and to review the safety and benefits of opioids for the individual patient. Medication stewardship and pharmacist integration are evolving approaches for general practice. Aim To explore enablers, barriers, and outcomes of a pharmacist-led intervention to improve opioid management in general practice, from the perspectives of general practitioners (GPs) and practice personnel. Method The study was part of a mixed-methods investigation into a general practice pharmacist pilot. Qualitative data relevant to opioids were analysed. Data from 13 semi-structured interviews were coded, analysed iteratively and thematically, and interpreted conceptually through the framework of Opioid Stewardship fundamentals proposed by the National Quality Forum. Results Seven themes and 14 subthemes aligned with stewardship fundamentals. Participants considered organisational policy, supported by leadership and education, fostered collaboration and consistency and improved practice safety. Patient engagement with individualised resources, 'agreements' and 'having the conversation' with the pharmacist enabled person-centred opioid review and weaning. GPs reported greater accountability and reflection in their practices, in the broader context of opioid prescribing and dilemmas in managing patients transitioning through care. Receiving feedback on practice deprescribing outcomes encouraged participants' ongoing commitment. Patient communication was deemed an early barrier; however, learnings were applied when transferring the model to other high-risk medicines. Conclusion Improved opioid management was enabled through implementing pharmacist-led coordinated stewardship. The findings offer a practical application of guideline advice to individualise opioid deprescribing.
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Langford AV, Gnjidic D, Lin CWC, Bero L, Blyth F, Penm J, Schneider CR. "The lesser of two evils": a framework analysis of consumers' perspectives on opioid deprescribing and the development of opioid deprescribing guidelines. Pain 2021; 162:2686-2692. [PMID: 33769364 DOI: 10.1097/j.pain.0000000000002270] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 02/22/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Deprescribing opioids has been identified as an intervention to mitigate opioid harm; however, it is often challenging to implement interventions and communicate deprescribing decisions to consumers. The development of opioid deprescribing guidelines may provide guidance and support on when and how to reduce or cease opioids in routine care. This study aimed to explore the perspectives of opioid consumers on opioid deprescribing and determine factors to be considered in the development of opioid deprescribing guidelines. A purposive sample of 20 consumers using opioids for pain was recruited. Semistructured interviews were conducted, audio recorded, and transcribed verbatim. Inductive thematic analysis was undertaken, followed by a framework analysis informed by Bandura's Social Cognitive Theory. Behavioral, cognitive, and environmental factors influence consumers' attitudes and actions regarding opioid deprescribing. Significant barriers to opioid deprescribing were identified, including fears of pain and withdrawal effects, opioid-related stigma, and perceived inadequacies of the healthcare system. Improved communication between healthcare professionals and consumers regarding expectations of deprescribing and goals of care, as well as the provision of greater opportunities for consumer engagement in decision making were identified as avenues to improve the success of opioid deprescribing. For opioid deprescribing guidelines to be effective and achieve the intended goal of optimizing opioid use, consumers need to feel empowered to engage in opioid reduction or cessation. The findings of this study may facilitate a patient-centred approach for practitioners and guideline developers in creating recommendations and interventions to enable opioid deprescribing through targeting behavioral change.
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Affiliation(s)
- Aili V Langford
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | - Danijela Gnjidic
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | - Chung-Wei Christine Lin
- Institute for Musculoskeletal Health, Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lisa Bero
- School of Medicine, Colorado School of Public Health and Center for Bioethics and Humanities, University of Colorado Anschutz Medical Center, Denver, CO, United States
| | - Fiona Blyth
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan Penm
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
- Department of Pharmacy, Prince of Wales Hospital, Randwick, Australia
| | - Carl R Schneider
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
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Rahman S, Trussell A, Pearson SA, Buckley NA, Karanges EA, Cairns R, Litchfield M, Todd A, Gisev N. Trends in transdermal fentanyl utilisation and fatal fentanyl overdose across Australia (2003-2015). Drug Alcohol Rev 2021; 41:435-443. [PMID: 34628699 DOI: 10.1111/dar.13391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Fentanyl-related overdose is an ongoing concern among countries with high prescription opioid utilisation. This study examines trends in transdermal fentanyl utilisation and fatal fentanyl overdose across Australia between 2003 and 2015, overall, and by age/sex. METHODS This was a retrospective nationwide study of prescription dispensings and coronial records. Transdermal fentanyl utilisation was examined using Pharmaceutical Benefits Scheme dispensing records. Details of fatal fentanyl overdoses were extracted from the National Coronial Information System. RESULTS Transdermal fentanyl utilisation increased 5.1-fold between 2003 and 2015, from 0.28 to 1.39 mg/1000 population/day and was consistently higher among females and adults aged ≥85 years. The utilisation of higher strength patches (75 and 100 mcg/h) was more common among males aged 25-44 years. A total of 291 fatal fentanyl overdoses were recorded, increasing from no recorded deaths in 2003 to 2.23 deaths/1 000 000 population in 2015. Rates were higher among males (increasing from 0 to 3.72 deaths/1 000 000 population) and for adults aged 25-44 years (increasing from 0 to 5.34 deaths/1 000 000 population). The number of deaths/kg fentanyl dispensed was highest among males aged <25 years (45.45, 95% confidence interval 21.80-83.59). Most deaths (70.1%) involved the intravenous administration of fentanyl from transdermal patches. DISCUSSION AND CONCLUSIONS Rates of transdermal fentanyl utilisation and fatal fentanyl overdose across Australia increased between 2003 and 2015. Although transdermal fentanyl utilisation was consistently greater among females and older adults, rates of fatal fentanyl overdose were highest among younger males. Interventions to reduce extramedical use among this high-risk population group are necessary to minimise fentanyl-related harms.
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Affiliation(s)
- Shafkat Rahman
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, Australia
| | - Alex Trussell
- The University of Sydney Medical School, The University of Sydney, Sydney, Australia
| | | | - Nicholas A Buckley
- The University of Sydney Medical School, The University of Sydney, Sydney, Australia.,NSW Poisons Information Centre, The Children's Hospital at Westmead, Sydney, Australia
| | - Emily A Karanges
- The University of Sydney School of Pharmacy, The University of Sydney, Sydney, Australia
| | - Rose Cairns
- NSW Poisons Information Centre, The Children's Hospital at Westmead, Sydney, Australia.,The University of Sydney School of Pharmacy, The University of Sydney, Sydney, Australia
| | - Melisa Litchfield
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, Australia
| | - Adam Todd
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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11
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Dunlop AJ, Lokuge B, Lintzeris N. Opioid prescribing in Australia: too much and not enough. Med J Aust 2021; 215:117-118. [PMID: 34272736 PMCID: PMC9292861 DOI: 10.5694/mja2.51180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/22/2021] [Accepted: 06/22/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Adrian J Dunlop
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW.,University of Newcastle, Newcastle, NSW
| | - Buddhima Lokuge
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW.,University of Newcastle, Newcastle, NSW
| | - Nicholas Lintzeris
- University of Sydney, Sydney, NSW.,Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW
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12
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Jordan M, Latif A, Mullan J, Chen TF. Opioid medicines management in primary care settings: A scoping review of quantitative studies of pharmacist activities. Br J Clin Pharmacol 2021; 87:4504-4533. [PMID: 34041786 DOI: 10.1111/bcp.14915] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/12/2021] [Accepted: 05/08/2021] [Indexed: 12/26/2022] Open
Abstract
To undertake a scoping review of pharmacist activities in opioid medicines management in primary care settings, including those developed or led by pharmacists, or in which pharmacists were members of broader multidisciplinary teams, and to collate the activities, models of care and settings, and reported outcomes. The bibliographic databases MEDLINE, EMBASE, International Pharmaceutical Abstracts, CINAHL, SCOPUS and Web of Science were searched. Studies with quantitative evaluation and published in English were eligible. Participants were patients with any pain category or an opioid use disorder, and healthcare providers. Studies originating in hospitals or involving supply functions were not included. Screening of literature and data charting of results were undertaken by two researchers. The 51 studies included in the scoping review occurred in primary care settings collated into four categories: general practice or primary care clinics, healthcare organisations, community pharmacies and outreach services. Studies were primarily of opioid use in chronic, noncancer pain. Other indications were opioid use disorder, cancer and dental pain. Pharmacist activities targeted risk mitigation, patient and provider education and broader, strategic approaches. Patient-related outcomes included reduced opioid load, improved functionality and symptom management, enhanced access to services and medication-assisted treatments, and engagement in risk-mitigation strategies. Behaviour change of providers was demonstrated. The review has identified the significant contribution that pharmacists working in primary care settings can make to minimise harm from opioids. Strategies implemented in isolation have the potential to further reduce adverse clinical outcomes with greater collaboration and coordination, such as opioid stewardship.
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Affiliation(s)
- Margaret Jordan
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Asam Latif
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Judy Mullan
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia.,Illawarra & Southern Practice Research Network, University of Wollongong, Wollongong, Australia
| | - Timothy F Chen
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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13
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Mian M, Teoh L, Hopcraft M. Trends in Dental Medication Prescribing in Australia during the COVID-19 Pandemic. JDR Clin Trans Res 2021; 6:145-152. [PMID: 33423578 PMCID: PMC7803793 DOI: 10.1177/2380084420986766] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic and subsequent restrictions on dental services have had a significant impact on the provision of dental care in Australia and around the world. OBJECTIVES To investigate the impact of COVID-19 on medications prescribed by dentists under the Australian Pharmaceutical Benefits Scheme (PBS). METHODS Data on the number of dental prescriptions dispensed for all medications listed on the PBS Dental Schedule, from January 2019 to June 2020, were extracted from publicly available data sets. Analysis of prescription trends was performed for 1) total medications, 2) each major medication class, and 3) individual medications. The number of prescriptions dispensed in each month from January 2020 to June 2020 was compared to the same month in 2019 to determine the relative (percentage) change, and z statistics were used to determine whether changes were statistically significant. RESULTS There was a significant decrease in dental prescriptions in April 2020 compared to April 2019 (14,785, 18%; P < 0.05). Decreases in prescriptions for antibiotics (10,512, 16%; P < 0.05) and opioid analgesics (3,129, 18%; P < 0.05) were smaller compared to other major medication classes. There was a significant increase in June 2020, compared with June 2019, for prescriptions of amoxicillin with clavulanic acid (4,903, 20%; P < 0.05), tramadol (89, 46%; P < 0.05), and oxycodone (381, 73%; P < 0.05). CONCLUSION Dental service restrictions during COVID-19 likely drove an unmet need for routine dental treatment, which had significant implications for public oral health following easing of restrictions. During the initial surge and subsequent lockdown, antibiotics and opioid analgesics may have been used an as alternative to routine operative treatment. Continued professional guidance is required to ensure dental prescribing remains evidence based during the pandemic period. KNOWLEDGE TRANSFER STATEMENT The COVID-19 pandemic and subsequent restrictions on dental practice have had a profound impact on the provision of dental care in Australia and elsewhere in the world. In this context, population-level medication surveillance is important to identify and respond to changes in prescribing patterns that have arisen due to COVID-19 and restrictions on the provision of dental care. This research is particularly important for governments, regulators, and professional associations to ensure therapeutic guidelines and recommendations during the pandemic period remain relevant and evidence based.
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Affiliation(s)
- M. Mian
- Oral and Maxillofacial Surgery Unit, Royal Dental Hospital of Melbourne, Carlton, Victoria, Australia
- Melbourne Medical School, University of Melbourne, Victoria, Australia
| | - L. Teoh
- Melbourne Dental School, University of Melbourne, Victoria, Australia
| | - M. Hopcraft
- Melbourne Dental School, University of Melbourne, Victoria, Australia
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14
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Taylor J, Pardo B, Hulme S, Bouey J, Greenfield V, Zhang S, Kilmer B. Illicit synthetic opioid consumption in Asia and the Pacific: Assessing the risks of a potential outbreak. Drug Alcohol Depend 2021; 220:108500. [PMID: 33461149 DOI: 10.1016/j.drugalcdep.2020.108500] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Illegally manufactured potent synthetic opioids (IMPSO) like fentanyl have contributed to rises in overdose deaths in parts of North America and Europe. While many of these substances are produced in Asia, there is little evidence they have entered markets there. We consider the susceptibility to IMPSO's encroachment in markets in the Asia-Pacific region. METHODS Our analysis focuses on Australia, China, India, and Myanmar. Using a mixed-methods approach comprising interviews, literature review, and secondary data analyses, we examine factors facilitating or impeding incursion of IMPSO. Finally, we illustrate the potential for IMPSO fatalities in Australia. RESULTS Australia reports some signs of three facilitating factors to IMPSO's emergence: 1) existing illicit opioid markets, 2) disruption of opioid supply, and 3) user preferences. The other three countries report only existing illicit opioid markets. While diverted pharmaceutical opioids are a noted problem in Australia and India, heroin is the dominant opioid in all four countries. There are divergent trends in heroin use, with use declining in China, increasing in India, and stable in Australia and Myanmar. If IMPSO diffused in Australia as in North America from 2014 to 2018, and our assumptions generally hold, deaths from IMPSO could range from 1500-5700 over a five-year period. CONCLUSIONS This analysis and illustrative calculations serve as an early indication for policymakers. With the exception of Australia, many countries in the region fail to properly record overdose deaths or monitor changes in local drug markets. Early assessment and monitoring can give officials a better understanding of these changing threats.
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Affiliation(s)
- Jirka Taylor
- RAND Corporation, 1200 South Hayes Street, Arlington, 22202 VA, United States.
| | - Bryce Pardo
- RAND Corporation, 1200 South Hayes Street, Arlington, 22202 VA, United States.
| | - Shann Hulme
- RAND Europe, Westbrook Centre, Milton Road, Cambridge, CB4 1YG, United Kingdom.
| | - Jennifer Bouey
- RAND Corporation, 1200 South Hayes Street, Arlington, 22202 VA, United States.
| | - Victoria Greenfield
- RAND Corporation, 1200 South Hayes Street, Arlington, 22202 VA, United States.
| | - Sheldon Zhang
- University of Massachusetts Lowell, 113 Wilder St, Health & Social Sciences Building, Suite 400, Lowell, MA, 01854, United States.
| | - Beau Kilmer
- RAND Corporation, 1200 South Hayes Street, Arlington, 22202 VA, United States.
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15
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Woolley M, Shao E, Iedema J, McCarron A. Reducing oxycodone prescription: audit on a hospital‐based intervention. Intern Med J 2020; 50:1440-1442. [DOI: 10.1111/imj.15054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 09/02/2020] [Accepted: 09/09/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Michael Woolley
- Department of Medicine Redland Hospital Cleveland Queensland Australia
| | - Emily Shao
- Department of Medicine Redland Hospital, University of Queensland Cleveland Queensland Australia
| | - Joel Iedema
- Department of Medicine Redland Hospital, University of Queensland Cleveland Queensland Australia
| | - Ashlea McCarron
- Department of Medicine Redland Hospital Cleveland Queensland Australia
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16
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Eidan A, Ratsch A, Burmeister EA, Griffiths G. Comparison of Opioid-Free Anesthesia Versus Opioid-Containing Anesthesia for Elective Laparoscopic Surgery (COFA: LAP): A Protocol Measuring Recovery Outcomes. Methods Protoc 2020; 3:mps3030058. [PMID: 32823720 PMCID: PMC7565777 DOI: 10.3390/mps3030058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 12/22/2022] Open
Abstract
The administration of opioids is a central element in contemporary anesthetic techniques in Australia; however, opioids have a range of side effects. As an alternative, opioid-free anesthesia (OFA) is an emerging mode of anesthesia intended to avoid these side effects. This study is the first to publish the use of OFA in Australia and is conducted in a regional Queensland Health Service. The design will utilize a randomized clinical trial (RCT) to investigate the impact of OFA for patients having an elective laparoscopic cholecystectomy (n = 40) or tubal ligation (n = 40). Participant outcomes to be measured include: Quality of Recovery (QoR-15); Oral Morphine Equivalent Daily Dose (OMEDD) at 24-h post-operatively; time to first opioid (TTFO) dose; post-operative nausea and vomiting (PONV); Post Anesthetic Care Unit length of stay (PACU-LOS); and hospital length of stay (LOS). The findings may challenge the essentiality of opioids in the peri-operative period, which in turn would influence the future intra-operative management of surgical patients. Ultimately, a reduction in anesthesia-associated opioid use will support a more general decline in opioid use.
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Affiliation(s)
- Anthony Eidan
- Anesthetic Department, Bundaberg Hospital, Wide Bay Hospital and Health Service, Bundaberg 4670, Australia;
- School of Medicine, The University of Queensland, Brisbane 4072, Australia
| | - Angela Ratsch
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane 4072, Australia; (E.A.B.); (G.G.)
- Nursing and Midwifery Services, Wide Bay Hospital and Health Service, Bundaberg 4670, Australia
- Correspondence:
| | - Elizabeth A. Burmeister
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane 4072, Australia; (E.A.B.); (G.G.)
- Nursing and Midwifery Services, Wide Bay Hospital and Health Service, Bundaberg 4670, Australia
| | - Geraldine Griffiths
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane 4072, Australia; (E.A.B.); (G.G.)
- Nursing and Midwifery Services, Wide Bay Hospital and Health Service, Bundaberg 4670, Australia
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17
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Associations between pre-surgical daily opioid use and short-term outcomes following knee or hip arthroplasty: a prospective, exploratory cohort study. BMC Musculoskelet Disord 2020; 21:398. [PMID: 32571280 PMCID: PMC7310486 DOI: 10.1186/s12891-020-03413-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background Retrospective studies have found that daily opioid use pre-arthroplasty predicts worse longer-term service, clinical and patient-reported outcomes. Prospective studies are needed to confirm these observations. This prospective, exploratory study aimed to determine: the proportion of total knee or hip arthroplasty (TKA, THA) patients who use opioids regularly (daily) pre-surgery; if opioid use pre-surgery is associated with acute and sub-acute outcomes to 12-weeks post-surgery. Methods Consecutive patients undergoing primary TKA or THA were prospectively enrolled pre-surgery and followed-up by telephone to 12-weeks post-surgery. Acute-care (oral morphine equivalent dosage (OMED), length of stay, discharge to inpatient rehabilitation, complications) and 12-week outcomes (Oxford Knee or Hip Score, Euroqol ‘today’ health score, current use of opioids, and complications including readmissions) were monitored. Unadjusted and adjusted Odds Ratios (ORs) (95% Confidence Interval, CI), Rate Ratios and β coefficients (standard error) were calculated. Results Five Hundred Twenty-One patients were included (TKA n = 381). 15.7% (95%CI 12.6 to 18.9) used opioids regularly pre-surgery. 86.8% (452/521) were available for follow-up at 12-weeks. In unadjusted analyses, pre-surgical opioid use was significantly associated with higher average acute daily OMED [β 0.40 (0.07), p < 0.001], presence of an acute complication [OR 1.75 (1.02 to 3.00)], and ongoing use of opioids at 12-weeks [OR 5.06 (2.86 to 8.93)]. After adjusting for covariates, opioid use pre-surgery remained significantly associated with average acute daily OMED [β 0.40 (0.07), p < 0.001] and ongoing use at 12-weeks [OR 5.38 (2.89 to 9.99)]. Conclusion People who take daily opioids pre-surgery have significantly greater odds for greater opioid consumption acutely and ongoing use post-surgery. Adequately powered prospective studies are required to confirm whether pre-surgical opioid use is or is not associated with poorer joint and quality of life scores or a complication in the short-term.
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18
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Pinkerton R, Mitchell G, Hardy J. Stringent Control of Opioids: Sound Public Health Measures, but a Step Too Far in Palliative Care? Curr Oncol Rep 2020; 22:34. [PMID: 32170510 DOI: 10.1007/s11912-020-0900-5] [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] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Opioids are the only class of drug with the proven ability to control severe pain. The introduction of stringent opioid prescribing restrictions has inevitably impacted upon the ability of those prescribing opioids for advanced life-limited disease to practice as previously and could limit the supply of adequate pain relief to patients with cancer. This review considers the evidence that symptom management of patients with advanced cancer contributes to the "opioid problem" and whether there is adequate recognition of the risks involved. RECENT FINDINGS The literature suggests that the risk of opioid abuse is low in the palliative care population as is the risk of legal consequences for doctors prescribing opioids at the end of life. However, as many patients with cancer are living longer or surviving with chronic pain, palliative care physicians must be cognisant not only of the risks of long term opioid use but also of the risk of opioid misuse. Adherence to evidence or consensus-based guidelines is necessary to avoid inappropriate prescribing. In palliative care, it is appropriate not only to exercise a reasonable degree of opioid control and surveillance, primarily for the good of society, but also to ensure that the ability to treat pain in patients with advanced malignant disease is not compromised.
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Affiliation(s)
- Ross Pinkerton
- Hummingbird House Children's Hospice, 60 Curwen Tce, Chermside, Queensland, 4032, Australia
| | | | - Janet Hardy
- Department of Palliative and Supportive Care, Mater Misericordiae Ltd, Mater Hospital Brisbane, Mater Research - University of Queensland, Raymond Tce, South Brisbane, Queensland, 4101, Australia.
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19
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Polasek T, Caramins M, Suthers G. Regulatory and other responses to the pharmaceutical opioid problem. Med J Aust 2019; 211:237-237.e1. [DOI: 10.5694/mja2.50297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Thomas Polasek
- Certara Princeton NJ USA
- Centre for Medicine Use and SafetyMonash University Melbourne VIC
| | - Melody Caramins
- Royal College of Pathologists of Australasia Sydney NSW
- Healius Sydney NSW
| | - Graeme Suthers
- Royal College of Pathologists of Australasia Sydney NSW
- Sonic Healthcare Sydney NSW
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20
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Islam MM, Wollersheim D. A comparison of opioids and benzodiazepines dispensing in Australia. PLoS One 2019; 14:e0221438. [PMID: 31425552 PMCID: PMC6699700 DOI: 10.1371/journal.pone.0221438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 08/06/2019] [Indexed: 11/19/2022] Open
Abstract
Background Inappropriate utilization of prescription opioids and benzodiazepines is a public health problem. This study examined and compared user-types and trends in dispensing of these medicines, and identified associated factors related to the duration of dispensing in Australia. Methods A random 10% sample of unit-record data of opioids and benzodiazepines dispensed nationally during 2013–2016 was analyzed. Users were categorized into four types: single-quarter (i.e., three months), medium-episodic (dispensed 2–6 quarters), long-episodic (dispensed 7–11 quarters), chronic (dispensed 12–16 quarters). Dispensing quantity was computed in defined daily dose (DDD). Generalized multilevel ordinal models were developed to examine the factors associated with the duration of dispensing. Results There were similarities in terms of trends of dispensing of opioids and benzodiazepines in Australia. Overall, more people were dispensed opioids than benzodiazepines. Around 52% of opioids users and 46% of benzodiazepines users were dispensed these medicines for a single quarter. However, chronic users were dispensed 60% of opioids and 50% of benzodiazepines in DDD/1000 people/day, respectively. On average, 16.6 DDD/1000 people/day of opioids and 14.2 DDD/1000 people/day of benzodiazepines were dispensed in Australia during the study period. Tasmania was dispensed the highest quantity (in DDD/1000 people/day) of these medicines, followed by South Australia and Queensland. Women compared to men, and clients of age-group 20–44, 45–64 and 65+ compared to age-group 0–19, were significantly more likely to have dispensed opioids/benzodiazepine for a relatively long duration. Clients with a history of dispensing of one of these two medicines were significantly more likely to have dispensed the other for a relatively long period. Conclusions There were similarities in patterns of dispensing of opioids and benzodiazepines in terms of user characteristics and structural variables. Consistent use of real-time drug monitoring program and tailored intervention are recommended.
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Affiliation(s)
- M. Mofizul Islam
- Department of Public Health, La Trobe University, Melbourne, Victoria, Australia
- * E-mail:
| | - Dennis Wollersheim
- Health Information Management, Department of Public Health, La Trobe University, Melbourne, Victoria, Australia
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21
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Campbell G, Larance B, Lintzeris N. Regulatory and other responses to the pharmaceutical opioid problem. Med J Aust 2019; 211:237-237.e1. [PMID: 31389014 DOI: 10.5694/mja2.50303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Gabrielle Campbell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW
| | - Briony Larance
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW.,University of Wollongong, Wollongong, NSW
| | - Nicholas Lintzeris
- University of Sydney, Sydney, NSW.,Drug and Alcohol Services, South Eastern Sydney Local Health District, Sydney, NSW
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