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Jung M, Xia T, Ilomäki J, Pearce C, Nielsen S. Trajectories of prescription opioid tapering in patients with chronic non-cancer pain: a retrospective cohort study, 2015-2020. Pain Med 2024; 25:263-274. [PMID: 38191211 PMCID: PMC10988287 DOI: 10.1093/pm/pnae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/30/2023] [Accepted: 12/16/2023] [Indexed: 01/10/2024]
Abstract
OBJECTIVE To identify common opioid tapering trajectories among patients commencing opioid taper from long-term opioid therapy for chronic non-cancer pain and to examine patient-level characteristics associated with these different trajectories. DESIGN A retrospective cohort study. SETTING Australian primary care. SUBJECTS Patients prescribed opioid analgesics between 2015 and 2020. METHODS Group-based trajectory modeling and multinomial logistic regression analysis were conducted to determine tapering trajectories and to examine demographic and clinical factors associated with the different trajectories. RESULTS A total of 3369 patients commenced a taper from long-term opioid therapy. Six distinct opioid tapering trajectories were identified: low dose / completed taper (12.9%), medium dose / faster taper (12.2%), medium dose / gradual taper (6.5%), low dose / noncompleted taper (21.3%), medium dose / noncompleted taper (30.4%), and high dose / noncompleted taper (16.7%). A completed tapering trajectory from a high opioid dose was not identified. Among patients prescribed medium opioid doses, those who completed their taper were more likely to have higher geographically derived socioeconomic status (relative risk ratio [RRR], 1.067; 95% confidence interval [CI], 1.001-1.137) and less likely to have sleep disorders (RRR, 0.661; 95% CI, 0.463-0.945) than were those who didn't complete their taper. Patients who didn't complete their taper were more likely to be prescribed strong opioids (eg, morphine, oxycodone), regardless of whether they were tapered from low (RRR, 1.444; 95% CI, 1.138-1.831) or high (RRR, 1.344; 95% CI, 1.027-1.760) doses. CONCLUSIONS Those prescribed strong opioids and high doses appear to be less likely to complete tapering. Further studies are needed to evaluate the clinical outcomes associated with the identified trajectories.
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Affiliation(s)
- Monica Jung
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, VIC 3199, Australia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia
| | - Ting Xia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, VIC 3199, Australia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC 3052, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Christopher Pearce
- Melbourne East General Practice Network (trading as Outcome Health), Surrey Hills, VIC 3127, Australia
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Melbourne, VIC 3168, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, VIC 3199, Australia
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Armour R, Grunau B, Iammarino S, Buxton J, Kinniburgh B, Burgess H, Sedgemore KO, Choisil P, Nielsen S, Ross L. Performance of the Medical Priority Dispatch System® in Identifying Patients Requiring Chest Compressions at Overdose Prevention Services: A Retrospective Cohort Study. PREHOSP EMERG CARE 2024:1-8. [PMID: 38407219 DOI: 10.1080/10903127.2024.2319150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 02/08/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND AND AIMS The Medical Priority Dispatch System (MPDS)® is used to triage 9-1-1 calls according to acuity, with certain coding receiving telecommunicator cardiopulmonary resuscitation (T-CPR) for suspected out-of-hospital cardiac arrest (OHCA). However, this may be challenging for those with drug poisoning emergencies, who may resemble OHCA. We sought to examine the performance of the system to correctly identify cases requiring T-CPR, specifically at overdose prevention services (OPS). METHODS This retrospective cohort study included patients attended by the provincial emergency medical system (EMS) (May 1, 2019-January 31, 2023). We calculated the diagnostic performance of MPDS® assessment of whether the case required T-CPR instructions against the gold standard of whether the patient was found pulseless on EMS clinician arrival. We compared performance among subgroups, specifically OPS vs other locations and drug poisoning-classified cases vs other case classifications. RESULTS Comparing OPS to other locations, the sensitivity of MPDS® was similar (66.7% vs 62.4%, p = 0.4), with lower specificity (87.3% vs 98.1%, p < 0.01) and positive predictive value (0.3% vs 35.7%, p < 0.01) and higher negative predictive value (99.9% vs 99.4%, p < 0.01). The negative likelihood ratio of MPDS® was 0.381 at OPS locations, compared with 0.383 at other locations, while the positive likelihood ratio was 5.24, compared with 32.36. In patients with drug poisoning emergencies, compared with other 9-1-1 events, MPDS® had higher sensitivity (83.6% vs 60.6%, p < 0.01) but lower specificity (77.6% vs 98.9%, p < 0.01) and positive predictive value (10.5% vs 48.5%, p < 0.01), and similar negative predictive value (99.33% vs 99.35%, p = 0.03). The negative likelihood ratio of MPDS® was 0.212 in drug poisoning emergencies compared with 0.398 for all other presentations, and the positive likelihood ratio was 3.73 compared with 57.88. DISCUSSION AND CONCLUSIONS The ability of MPDS® to correctly identify patients needing telecommunicator cardiopulmonary resuscitation instructions differed between OPS settings and other locations, frequently recommending T-CPR for patients not suffering OHCA at an OPS. Different strategies developed in collaboration with people who use substances are required to better tailor dispatch instructions prior to EMS arrival to avoid delays in life-saving interventions.
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Affiliation(s)
- Richard Armour
- Department of Paramedicine, School of Primary and Allied Health Care, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Ambulance Victoria, Doncaster, Victoria, Australia
- British Columbia Resuscitation Research Collaborative, Vancouver, British Columbia, Canada
- Monash Addiction Research Centre, Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Brian Grunau
- British Columbia Resuscitation Research Collaborative, Vancouver, British Columbia, Canada
- Department of Emergency Medicine, University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
- British Columbia Emergency Health Services, Vancouver, British Columbia, Canada
| | - Sammy Iammarino
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- Faculty of Applied Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jane Buxton
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brooke Kinniburgh
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Heather Burgess
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Kali-Olt Sedgemore
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Paul Choisil
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Linda Ross
- Department of Paramedicine, School of Primary and Allied Health Care, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Lancaster K, Gendera S, Treloar C, Rhodes T, Shahbazi J, Byrne M, Nielsen S, Degenhardt L, Farrell M. Tinkering with care: Implementing extended-release buprenorphine depot treatment for opioid dependence. Int J Drug Policy 2024; 126:104359. [PMID: 38382354 DOI: 10.1016/j.drugpo.2024.104359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 02/23/2024]
Abstract
We examine how extended-release buprenorphine depot (BUP-XR) is put to use and made to work in implementation practices, attending to how care practices are challenged and adapted as a long-acting technology is introduced into service in opioid agonist treatment (OAT) in Australia. Our approach is informed by ideas in science and technology studies (STS) emphasising the irreducible entanglement of care practices and technology, and in particular the concept of 'tinkering' as a practice of adaptation. To make our analysis, we draw on qualitative interview accounts (n = 19) of service providers involved in BUP-XR implementation across five sites. Our analysis considers the disruptive novelty of BUP-XR. Tinkering to make a novel technology work in practice slows down the expectation of implementation in relation to transformative innovation, despite the promise of dramatic or rapid change. Tinkering allowed for more open relations, for new care practices that departed from the routine and familiar, opening potential for how BUP-XR could be put to use and made to work in its new situation, and as its situation evolved along-with its implementation. Flexibility and openness of altering relations was, however, at times, held in tension with inflexibility and closure. This analysis identifies a concern for what is made present and what is made absent in the altered care network affected by BUP-XR, with the multiple effects of supervised daily dosing practices thrown into relief as they become absented. Tinkering to implement BUP-XR locally connects with a broader assemblage of trial and movement in the constitution of treatment. The introduction of long-acting technologies prompts new questions about embedded implementation practices, including supervised dosing, urinalysis, the time and place of psychosocial support, and how other social aspects of care might be recalibrated in drug treatment.
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Affiliation(s)
- K Lancaster
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia; Goldsmiths, University of London, UK.
| | - S Gendera
- Social Policy Research Centre, University of New South Wales, Sydney, Australia
| | - C Treloar
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - T Rhodes
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia; London School of Hygiene and Tropical Medicine, UK
| | - J Shahbazi
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - M Byrne
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - S Nielsen
- Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - L Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - M Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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Nielsen S, Stowe MJ, Ritter A. In pursuit of safer supply: An emerging evidence base for medical and nonmedical models. Int J Drug Policy 2024; 126:104365. [PMID: 38417226 DOI: 10.1016/j.drugpo.2024.104365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 03/01/2024]
Affiliation(s)
- Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Peninsula Campus Rm 205A, Level 2, Building D, 47-49 Moorooduc Hwy, Frankston 3199, Victoria, Australia.
| | - M J Stowe
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Alison Ritter
- The Drug Policy Modelling Program, UNSW Sydney, Australia
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Farrell M, Shahbazi J, Chambers M, Byrne M, Gholami J, Zahra E, Grebely J, Lintzeris N, Larance B, Ali R, Nielsen S, Dunlop A, Dore GJ, McDonough M, Montebello M, Weiss R, Rodgers C, Cook J, Degenhardt L. 96-week retention in treatment with extended-release subcutaneous buprenorphine depot injections among people with opioid dependence: Extended follow-up after a single-arm trial. Int J Drug Policy 2024; 127:104390. [PMID: 38522175 DOI: 10.1016/j.drugpo.2024.104390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 03/07/2024] [Accepted: 03/07/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND The most recent formulation of buprenorphine treatment is extended-release depot injections (BUP-XR) that are administered subcutaneously by health care professionals. This study aimed to observe treatment outcomes of BUP-XR delivered in standard practice during a 96-week follow-up period in a community setting. METHODS This study is an extension of the CoLAB study, a prospective single-arm, multicentre, open label trial (N=100, 7 sites in Australia) among people with opioid dependence who received monthly injections of BUP-XR to evaluate the retention in treatment. Participants were followed for 96 weeks, comprising 48 weeks of the CoLAB study followed by a 48-week extension. RESULTS Of 100 participants at baseline, 47 were retained on BUP-XR at 96 weeks. The median time retained on monthly depot was 90 weeks. Heroin use (adjusted OR=0.19, P=0.012) in the month prior to baseline was associated with lower odds of retention on BUP-XR. Older age at first opioid use (adjusted OR= 1.08, P=0.009) and longer duration in OAT at baseline (adjusted OR= 1.12, P=0.001) were associated with increased retention. Prevalence of past four-weeks opioid use was estimated at 4% at 96 weeks of treatment (prevalence 0.04, 95%CI: 0.00-0.11) compared to 15% at baseline. Quality of life and medication treatment satisfaction improved over time for those retained in treatment. CONCLUSION This is one of the few studies to describe long term (96 week) retention in treatment with BUP-XR in a community setting. It displayed retention rates with 47% of participants completing 96 weeks of treatment with BUP-XR. Patient reported outcomes suggest improvements in client wellbeing. FUNDING Indivior.
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Affiliation(s)
| | | | - Mark Chambers
- National Drug and Alcohol Research Centre, UNSW, Australia
| | - Marianne Byrne
- National Drug and Alcohol Research Centre, UNSW, Australia; The Kirby Institute, UNSW, Australia
| | - Jaleh Gholami
- National Drug and Alcohol Research Centre, UNSW, Australia
| | - Emma Zahra
- National Drug and Alcohol Research Centre, UNSW, Australia
| | | | - Nicholas Lintzeris
- Discipline of Addiction Medicine, University of Sydney, NSW, Australia; Drug and Alcohol Services, South East Sydney Local Health District, Surry Hills, NSW, Australia
| | - Briony Larance
- National Drug and Alcohol Research Centre, UNSW, Australia; School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Robert Ali
- National Drug and Alcohol Research Centre, UNSW, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Suzanne Nielsen
- National Drug and Alcohol Research Centre, UNSW, Australia; Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, Australia
| | - Adrian Dunlop
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, NSW, Australia; Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | | | - Michael McDonough
- Drug and Alcohol Services South Australia, Adelaide, South Australia, Australia
| | - Mark Montebello
- National Drug and Alcohol Research Centre, UNSW, Australia; Discipline of Addiction Medicine, University of Sydney, NSW, Australia; Drug and Alcohol Services, North Sydney Local Health District, St Leonards, NSW, Australia
| | - Rob Weiss
- Frankston Healthcare, Frankston, Victoria, Australia
| | - Craig Rodgers
- Alcohol and Drug Service, St Vincent's Hospital, Darlinghurst NSW Australia
| | - Jon Cook
- Drug and Alcohol Clinical Advisory Service, Western Health, Victoria, Australia
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Tefera YG, Di Donato M, Sheehan LR, Gray S, Nielsen S, Xia T, Collie A. Capture, coding and reporting of healthcare and medicine information in Australian workers' compensation systems. J Occup Environ Med 2024:00043764-990000000-00525. [PMID: 38509656 DOI: 10.1097/jom.0000000000003084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
OBJECTIVE This study aims to characterise the approaches to collecting, coding, and reporting healthcare and medicines data within Australian workers' compensation schemes. METHODS We conducted a cross-sectional survey of data and information professionals in major Australian workers' compensation jurisdictions. Questionnaires were developed with input from key informants and a review of existing documentation. RESULTS Twenty-five participants representing regulators (40%) and insurers (60%) with representation from all Australian jurisdictions were included. Health care and medicines data sources, depth, coding standards and reporting practices exhibited significant variability across the Australian workers' compensation schemes. CONCLUSION Substantial variability exist in the capture, coding and reporting of healthcare and medicine data in Australian workers' compensation jurisdictions. There are opportunities to advance understanding of medicines and health service delivery in these schemes through greater harmonisation of data collection, data coding and reporting.
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Affiliation(s)
- Yonas Getaye Tefera
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University
| | - Michael Di Donato
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University
| | - Luke R Sheehan
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University
| | - Shannon Gray
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University
| | - Ting Xia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University
| | - Alex Collie
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University
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Tefera YG, Gray S, Nielsen S, Collie A. Preoperative opioid use and postoperative return to work following spinal surgery in workers' compensation settings: a systematic review and meta-analysis. Int J Surg 2024; 110:1781-1792. [PMID: 38181114 PMCID: PMC10942173 DOI: 10.1097/js9.0000000000001035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/11/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Opioid use prior to spinal surgery is common among patients with workers' compensation (WC) claims. Extended opioid use for pain management in this population is associated with several adverse outcomes including delayed return to work (RTW). OBJECTIVE This systematic review and meta-analysis aim to assess the evidence on the association of preoperative opioid use with stable RTW and RTW within 1-year after spinal surgery. MATERIAL AND METHODS The authors searched MEDLINE, Embase, PsycINFO, Emcare, CINAHL Plus, Scopus, and Web of Science from inception to 14 January 2023. The authors included studies that compared any preoperative opioid use with no opioid use, and those that enabled a comparison of different durations of preoperative opioid use. The primary outcome was stable RTW after spinal surgery. Secondary outcomes were RTW within 1-year after surgery and cost of WC claims. A random effect model was assumed to pool the effect estimate. The GRADE approach was applied to evaluate the certainty of evidence. RESULTS From 2589 records, 10 studies were included, and of these, nine were considered for quantitative synthesis. All studies were observational with eight retrospective cohort and two case-control studies. Five studies each investigated cervical and lumbar disorders. With moderate certainty evidence, the odds of postoperative stable RTW reduced by half (OR: 0.51, 95% CI: 0.43-0.59; 5549 participants) in patients using opioids preoperatively. Similarly, moderate certainty evidence from 2348 participants demonstrated that the odds of RTW within 1-year after surgery were reduced by more than half in patients with preoperative opioid prescriptions (OR: 0.46, 95% CI: 0.36-0.59). CONCLUSIONS This systematic review and meta-analysis shows that preoperative opioid use is associated with a reduction in odds of postoperative RTW by half in patients with WC-funded spinal surgery.
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Affiliation(s)
- Yonas G. Tefera
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School
| | - Alex Collie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Hayes MJ, Beavon E, Traeger MW, Dillon JF, Radley A, Nielsen S, Byrne CJ, Richmond J, Higgs P, Hellard ME, Doyle JS. Viral hepatitis testing and treatment in community pharmacies: a systematic review and meta-analysis. EClinicalMedicine 2024; 69:102489. [PMID: 38440399 PMCID: PMC10909633 DOI: 10.1016/j.eclinm.2024.102489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/28/2024] [Accepted: 01/31/2024] [Indexed: 03/06/2024] Open
Abstract
Background The World Health Organization seeks to eliminate viral hepatitis as a public health threat by 2030. This review and meta-analysis aims to evaluate the effectiveness of programs for hepatitis B and C testing and treatment in community pharmacies. Methods Medline, Embase, Cochrane CENTRAL, and Global Health were searched from database inception until 12 November 2023. Comparative and single arm intervention studies were eligible for inclusion if they assessed delivery of any of the following interventions for hepatitis B or C in pharmacies: (1) pre-testing risk assessment, (2) testing, (3) pre-treatment assessment or (4) treatment. Primary outcomes were proportions testing positive and reaching each stage in the cascade. Random effects meta-analysis was used to estimate pooled proportions stratified by recruitment strategy and setting where possible; other results were synthesised narratively. This study was pre-registered (PROSPERO: CRD42022324218). Findings Twenty-seven studies (4 comparative, 23 single arm) were included, of which 26 reported hepatitis C outcomes and four reported hepatitis B outcomes. History of injecting drug use was the most identified risk factor from pre-testing risk assessments. The pooled proportion hepatitis C antibody positive from of 19 studies testing 5096 participants was 16.6% (95% CI 11.0%-23.0%; heterogeneity I2 = 96.6%). The pooled proportion antibody positive was significantly higher when testing targeted people with specified risk factors (32.5%, 95% CI 24.8%-40.6%; heterogeneity I2 = 82.4%) compared with non-targeted or other recruitment methods 4.0% (95% CI 2.1%-6.5%; heterogeneity I2 = 83.5%). Meta-analysis of 14 studies with 813 participants eligible for pre-treatment assessment showed pooled attendance rates were significantly higher in pharmacies (92.7%, 95% CI 79.1%-99.9%; heterogeneity I2 = 72.4%) compared with referral to non-pharmacy settings (53.5%, 95% CI 36.5%-70.1%; heterogeneity I2 = 92.3%). The pooled proportion initiating treatment was 85.6% (95% CI 74.8%-94.3%; heterogeneity I2 = 75.1%). This did not differ significantly between pharmacy and non-pharmacy settings. Interpretation These findings add pharmacies to the growing evidence supporting community-based testing and treatment for hepatitis C. Few comparative studies and high degrees of statistical heterogeneity were important limitations. Hepatitis B care in pharmacies presents an opportunity for future research. Funding None.
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Affiliation(s)
| | | | - Michael W. Traeger
- Burnet Institute, Melbourne, Australia
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, USA
| | - John F. Dillon
- Division of Molecular and Clinical Medicine, University of Dundee School of Medicine, Dundee, UK
- Department of Gastroenterology, Ninewells Hospital and Medical School, Dundee, UK
| | - Andrew Radley
- Division of Molecular and Clinical Medicine, University of Dundee School of Medicine, Dundee, UK
- NHS Tayside, Dundee, UK
| | - Suzanne Nielsen
- Burnet Institute, Melbourne, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Christopher J. Byrne
- Division of Molecular and Clinical Medicine, University of Dundee School of Medicine, Dundee, UK
- NHS Tayside, Dundee, UK
| | | | - Peter Higgs
- Burnet Institute, Melbourne, Australia
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Margaret E. Hellard
- Burnet Institute, Melbourne, Australia
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, USA
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Joseph S. Doyle
- Burnet Institute, Melbourne, Australia
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Australia
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Moullin JC, Staniland L, Uren H, Nielsen S, Lenton S. Advancing the implementation of take-home naloxone by community pharmacists: Testing the role of COM-B. Drug Alcohol Rev 2024; 43:746-759. [PMID: 38287683 DOI: 10.1111/dar.13805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 01/31/2024]
Abstract
INTRODUCTION Opioid-related overdose fatalities are rising despite the increased accessibility of take-home naloxone (THN). Targeted implementation strategies are needed to improve the distribution of naloxone. This study investigates the effectiveness of a short video targeting pharmacists that addresses implementation barriers. METHODS A pre-post, mixed methods design was adopted to examine the effect of a brief behaviour change intervention (an educational video informed by the capability, opportunity, motivation affecting behaviour (COM-B) model), on factors affecting pharmacists' implementation of THN in Western Australia. Paired samples t-tests for were used to investigate intentions, knowledge, skill, confidence, feasibility, appropriateness, acceptability, attitudes, anticipated patient reactions, social support and implementation climate. Structural equation modelling examined the associations between constructs and to test the proposed mediation of motivation on capability and opportunity affecting intentions to discuss and provide THN. RESULTS We analysed data from 102 participants. At follow-up and after all participants had viewed the video, participants had significantly improved intentions, skill, confidence, anticipated reactions, social support and perceptions that THN implementation was feasible, appropriate and acceptable. No significant differences were seen for attitudes, knowledge or implementation climate. The proposed mediation effect of motivation on the associations between opportunity and intentions and capability and intentions was not supported. DISCUSSION AND CONCLUSIONS A short video directly targeting identified implementation barriers has the ability to improve key influences in the provision of THN. Dissemination of information to community pharmacists is a challenge. Implementation strategies addressing knowledge and targeting other levels of influence on intentions and behaviour are required.
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Affiliation(s)
- Joanna C Moullin
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- enAble Institute, Curtin University, Perth, Australia
| | | | - Hannah Uren
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - Simon Lenton
- enAble Institute, Curtin University, Perth, Australia
- National Drug Research Institute, Curtin University, Perth, Australia
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Xia T, Picco L, Buchbinder R, Haas R, Nielsen S. Association of state-level prescription drug monitoring program implementation with opioid prescribing transitions in primary care in Australia. Br J Clin Pharmacol 2024. [PMID: 38308463 DOI: 10.1111/bcp.15996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 12/10/2023] [Accepted: 12/13/2023] [Indexed: 02/04/2024] Open
Abstract
AIMS This study aimed to evaluate whether voluntary and mandatory prescription drug monitoring program (PDMP) use in Victoria, Australia, had an impact on prescribing behaviour, focusing on individual patients' prescribed opioid doses and transition to prescribing of nonmonitored medications. METHODS This was a retrospective cross-sectional study using routinely collected primary healthcare data. A 90-day moving average prescribed opioid dose in oral morphine equivalents was used to estimate opioid dosage. A Markov transition matrix was used to describe how patients prescribed medications transitioned between opioid dose groups and other nonopioid treatment options during 3 transition periods: transition between 2 control periods prior to PDMP implementation (T1 to T2); during the voluntary PDMP implementation (T2 to T3); and during mandatory PDMP implementation (T3 to T4). RESULTS Among patients prescribed opioids in our study, we noted an increased probability of transitioning to not being prescribed opioids during the mandatory PDMP period (T3 to T4). This increase was attributed mainly to the ceasing of low-dose opioid prescribing. Membership in an opioid dose group remained relatively stable for most patients who were prescribed high opioid doses. For those who were only prescribed nonmonitored medications initially, the probability of being prescribed opioids increased during the mandatory PDMP when compared to other transition periods. CONCLUSION The introduction of PDMP mandates appeared to have an impact on the prescribing for patients who were prescribed low-dose opioids, while its impact on individuals prescribed higher opioid doses was comparatively limited.
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Affiliation(s)
- Ting Xia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Rachelle Buchbinder
- Musculoskeletal Health and Sustainable Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Romi Haas
- Musculoskeletal Health and Sustainable Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
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McCoy J, Nielsen S, Bruno R. Development and validation of a brief screening tool for over-the-counter codeine dependence. Res Social Adm Pharm 2024; 20:182-189. [PMID: 38071124 DOI: 10.1016/j.sapharm.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Low-dose codeine is sold without a prescription in countries like the UK, Ireland, and South Africa. Due to misuse concerns, exploring pharmacy screening tools to identify those at risk and needing additional support is vital. OBJECTIVES The study aims to develop and validate a brief screening tool that assesses the risk of codeine dependence with language appropriate for routine use in community pharmacies. METHOD Scale development and validation occurred over two studies. In Study 1, scale item generation was based on structured analyses of psychosocial and pharmacy variables from frequent over-the-counter codeine consumers (N = 795). CFA was used to assess the cohesiveness of the resultant four-item Codeine Dependence Scale (CDS). ROC analyses were used to assess the performance of the CDS against risk cases identified by the Severity of Dependence Scale; identifying an optimal cut-off value of ≥2 as representing individuals at risk of codeine dependence. In Study 2, this CDS threshold was assessed against positive DSM-5 Opioid Use Disorder (OUD) cases related to codeine use assessed using the AUDADIS-IV. RESULTS With a cut-off score of ≥2, the CDS has sensitivity and specificity of 76% and 48%, respectively, against a DSM-5 codeine-related OUD diagnosis using the AUDADIS-IV. For identification of any codeine-related OUD (as measured by the AUDADIS-IV) 15 months after baseline, the CDS achieved an overall correct classification rate of 52%; 72% for positive cases. CONCLUSIONS The CDS exhibits reasonable cross-sectional and longitudinal sensitivity but low specificity, partly due to its brevity. However, the inclusive nature of the CDS is not a negative for application as a screening tool in a pharmacy setting as individual CDS items represent critical conversation points with a pharmacist, regardless of the screening outcome. The non-confronting nature of CDS items make the scale a viable option for pharmacy-based SBI in countries where codeine remains OTC.
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Affiliation(s)
- Jacqui McCoy
- University of Tasmania, Churchill Ave, Hobart, TAS, 7005, Australia.
| | - Suzanne Nielsen
- Monash University, Wellington Rd, Clayton, VIC, 3800, Australia.
| | - Raimondo Bruno
- University of Tasmania, Churchill Ave, Hobart, TAS, 7005, Australia.
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12
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Michell E, Lam T, Xia T, Nielsen S, Stevens J. The relationship between presurgical opioid type and persistent postoperative opioid use: a retrospective observational linkage study comparing tapentadol and oxycodone. Anaesthesia 2024; 79:203-205. [PMID: 37932877 DOI: 10.1111/anae.16164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 11/08/2023]
Affiliation(s)
- E Michell
- St Vincent's Clinical Campus, Darlinghurst, UNSW Sydney
| | - T Lam
- Eastern Health Clinical School, Monash University, Frankston, VIC, Australia
| | - T Xia
- Eastern Health Clinical School, Monash University, Frankston, VIC, Australia
| | - S Nielsen
- Eastern Health Clinical School, Monash University, Frankston, VIC, Australia
| | - J Stevens
- St Vincent's Clinical School, UNSW Medicine, Darlinghurst, NSW, Australia
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13
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Langford AV, Bero L, Lin CWC, Blyth FM, Doctor JN, Holliday S, Jeon YH, Moullin JC, Murnion B, Nielsen S, Penm J, Reeve E, Reid S, Wale J, Osman R, Gnjidic D, Schneider CR. Context matters: using an Evidence to Decision (EtD) framework to develop and encourage uptake of opioid deprescribing guideline recommendations at the point-of-care. J Clin Epidemiol 2024; 165:111204. [PMID: 37931823 DOI: 10.1016/j.jclinepi.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 10/23/2023] [Accepted: 10/30/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES To describe the development and use of an Evidence to Decision (EtD) framework when formulating recommendations for the Evidence-Based Clinical Practice Guideline for Deprescribing Opioid Analgesics. STUDY DESIGN AND SETTING Evidence was derived from an overview of systematic reviews and qualitative studies conducted with healthcare professionals and people who take opioids for pain. A multidisciplinary guideline development group conducted extensive EtD framework review and iterative refinement to ensure that guideline recommendations captured contextual factors relevant to the guideline target setting and audience. RESULTS The guideline development group considered and accounted for the complexities of opioid deprescribing at the individual and health system level, shaping recommendations and practice points to facilitate point-of-care use. Stakeholders exhibited diverse preferences, beliefs, and values. This variability, low certainty of evidence, and system-level policies and funding models impacted the strength of the generated recommendations, resulting in the formulation of four 'conditional' recommendations. CONCLUSION The context within which evidence-based recommendations are considered, as well as the political and health system environment, can contribute to the success of recommendation implementation. Use of an EtD framework allowed for the development of implementable recommendations relevant at the point-of-care through consideration of limitations of the evidence and relevant contextual factors.
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Affiliation(s)
- Aili V Langford
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Faculty of Medicine and Health, School of Pharmacy, 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, USA
| | - Chung-Wei Christine Lin
- Faculty of Medicine and Health, School of Public Health, Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia; Sydney Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Fiona M Blyth
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jason N Doctor
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
| | - Simon Holliday
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Yun-Hee Jeon
- Faculty of Medicine and Health, Sydney Nursing School, The University of Sydney, Sydney, New South Wales, Australia
| | - Joanna C Moullin
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Bridin Murnion
- Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, 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
| | - Emily Reeve
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Sharon Reid
- Specialty of Addiction Medicine, Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Drug Health Services, Royal Prince Alfred Hospital, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Janet Wale
- Independent Consumer Representative, Melbourne, Victoria, Australia
| | - Rawa Osman
- NPS MedicineWise, Sydney, New South Wales, Australia
| | - Danijela Gnjidic
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Sydney, New South Wales, 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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14
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Ng R, Gunatillaka N, Skouteris H, Blane D, Blewitt C, Nielsen S, Sturgiss E. Screening for Unstable Housing in a Healthcare Setting. Public Health Rev 2023; 44:1606438. [PMID: 38205340 PMCID: PMC10777743 DOI: 10.3389/phrs.2023.1606438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/13/2023] [Indexed: 01/12/2024] Open
Abstract
Objectives: To describe existing tools for screening patients for unstable housing in a healthcare setting. Methods: A literature search was completed to retrieve articles published in the last 10 years on screening patients for unstable housing in a healthcare setting. Results: The current literature on screening patients for homelessness in healthcare settings describes a variety of tools administered by a range of healthcare providers, but all are based in the United States. Conclusion: The studies revealed the potential for effective screening in healthcare settings and positive engagement of patients and providers with screening. Key areas for future research include innovative methods of screening and evaluation of reliability and validity for a broader range of tools.
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Affiliation(s)
- Raeann Ng
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, VIC, Australia
| | - Nilakshi Gunatillaka
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, VIC, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - David Blane
- Department of General Practice and Primary Care, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Claire Blewitt
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Elizabeth Sturgiss
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, VIC, Australia
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15
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Jung M, Xia T, Ilomäki J, Pearce C, Nielsen S. Opioid characteristics and nonopioid interventions associated with successful opioid taper in patients with chronic noncancer pain. Pain 2023:00006396-990000000-00479. [PMID: 38112755 DOI: 10.1097/j.pain.0000000000003133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 11/04/2023] [Indexed: 12/21/2023]
Abstract
ABSTRACT Current research indicates that tapering opioids may improve pain and function in patients with chronic noncancer pain. However, gaps in the literature remain regarding the choice of opioid and nonopioid interventions to support a successful taper. This study used an Australian primary care data set to identify a cohort of patients on long-term opioid therapy commencing opioid taper between January 2016 and September 2019. Using logistic regression analysis, we compared key clinical factors associated with differing taper outcomes. Of a total of 3371 patients who commenced taper, 1068 (31.7%) completed taper within 12 months. In the 3 months after commencement of taper, compared with those who did not complete taper, patients who successfully completed opioid taper were less likely to be prescribed buprenorphine (odds ratio [OR] 0.691; 95% CI: 0.530-0.901), fentanyl (OR, 0.429; 95% CI: 0.295-0.622), and long-acting (LA) opioids, including methadone (OR, 0.349; 95% CI: 0.157-0.774), oxycodone-naloxone (OR, 0.521; 95% CI: 0.407-0.669), and LA tapentadol (OR, 0.645; 95% CI: 0.461-0.902), but more likely to be prescribed codeine (OR, 1.308; 95% CI: 1.036-1.652). Compared with those who did not complete taper, patients who successfully tapered were less likely to be prescribed any formulations of oxycodone (short-acting [SA]: OR, 0.533; 95% CI: 0.422-0.672, LA: OR, 0.356; 95% CI: 0.240-0.530) and tramadol (SA: OR, 0.370; 95% CI: 0.218-0.628, LA: OR, 0.317; 95% CI: 0.234-0.428). The type of opioid prescribed in the months after commencement of taper seems to influence the taper outcomes. These findings may inform prospective studies on opioid taper.
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Affiliation(s)
- Monica Jung
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Ting Xia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Christopher Pearce
- Melbourne East General Practice Network (trading as Outcome Health), Surrey Hills, Australia
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Notting Hill, Melbourne, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
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16
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Tefera YG, Gray S, Nielsen S, Gelaw A, Collie A. Impact of Prescription Medicines on Work-Related Outcomes in Workers with Musculoskeletal Disorders or Injuries: A Systematic Scoping Review. J Occup Rehabil 2023:10.1007/s10926-023-10138-y. [PMID: 37934329 DOI: 10.1007/s10926-023-10138-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/10/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE Medicines are often prescribed to workers with musculoskeletal disorders (MSDs) and injuries to relieve pain and facilitate their recovery and return to work. However, there is a growing concern that prescription medicines may have adverse effects on work function. This scoping review aimed to summarize the existing empirical evidence on prescription medicine use by workers with MSD or injury and its relationship with work-related outcomes. METHODS We identified studies through structured searching of MEDLINE, EMBASE, PsycINFO, CINAHL Plus, Scopus, Web of Science and Cochrane library databases, and via searching of dissertations, theses, and grey literature databases. Studies that examined the association between prescription medicine and work-related outcomes in working age people with injury or MSDs, and were published in English after the year 2000 were eligible. RESULTS From the 4884 records identified, 65 studies were included for review. Back disorders and opioids were the most commonly studied musculoskeletal conditions and prescription medicines, respectively. Most studies showed a negative relationship between prescription medicines and work outcomes. Opioids, psychotropics and their combination were the most common medicines associated with adverse work outcomes. Opioid prescriptions with early initiation, long-term use, strong and/or high dose and extended pre- and post-operative use in workers' compensation setting were consistently associated with adverse work function. We found emerging but inconsistent evidence that skeletal muscle relaxants and non-steroidal anti-inflammatory drugs were associated with unfavorable work outcomes. CONCLUSION Opioids and other prescription medicines might be associated with adverse work outcomes. However, the evidence is conflicting and there were relatively fewer studies on non-opioid medicines. Further studies with more robust design are required to enable more definitive exploration of causal relationships and settle inconsistent evidence.
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Affiliation(s)
- Yonas Getaye Tefera
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Shannon Gray
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, 47-49 Moorooduc Hwy, Frankston, 3199, Australia
| | - Asmare Gelaw
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Alex Collie
- Healthy Working Lives Research Group, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
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Picco L, Xia T, Bell JS, Pearce C, Buchbinder R, Lubman DI, Nielsen S. Changes in opioid agonist treatment initiation among people prescribed opioids for pain following voluntary and mandatory prescription drug monitoring program implementation: A time series analysis. Drug Alcohol Rev 2023; 42:1639-1646. [PMID: 37798947 PMCID: PMC10947011 DOI: 10.1111/dar.13754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION Prescription drug monitoring programs (PDMP) are increasingly used to identify people prescribed high-dose opioids. However, little is known about whether PDMPs impact opioid agonist treatment (OAT) uptake, the gold standard for opioid use disorder. This study examined the impact of PDMP implementation on OAT initiation among people prescribed opioids, in Victoria, Australia. METHODS De-identified electronic records from all 464 Victorian general practices included in the POLAR database were used. OAT initiation was defined as a new OAT prescription between 1 April 2017 and 31 December 2020, with no OAT prescriptions in the year prior. Interrupted time series analyses were used to compare outcomes before (April 2017 to March 2019) and after (April 2019 to December 2020) PDMP implementation. Binary logistic regression was used to examine differences in patients' characteristics associated with OAT initiation prior to and after PDMP implementation. RESULTS In total, 1610 people initiated OAT, 946 before and 664 after PDMP implementation. No significant immediate (step) or longer-term (slope) changes in the rates of OAT initiation were identified following PDMP implementation, after adjusting for seasonality. A high opioid dose (>100 mg oral morphine equivalent) in the 6-months prior to OAT initiation was the only significant characteristic associated with reduced odds of OAT initiation post-PDMP implementation (odds ratio 0.29; 0.23-0.37). DISCUSSION AND CONCLUSIONS PDMP implementation did not have a significant impact on OAT initiation among people prescribed opioids. Findings suggest additional clinical initiatives that support OAT initiation are required to ensure PDMPs meet their intended target of reducing opioid-related harms.
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Affiliation(s)
- Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
| | - Ting Xia
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
| | - J. Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityMelbourneAustralia
- School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | | | - Rachelle Buchbinder
- School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Dan I. Lubman
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
- Turning Point, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
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18
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Xia T, Picco L, Lalic S, Buchbinder R, Bell JS, Andrew NE, Lubman DI, Pearce C, Nielsen S. Determining the Impact of Opioid Policy on Substance Use and Mental Health-Related Harms: Protocol for a Data Linkage Study. JMIR Res Protoc 2023; 12:e51825. [PMID: 37847553 PMCID: PMC10618880 DOI: 10.2196/51825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 08/21/2023] [Accepted: 08/21/2023] [Indexed: 10/18/2023] Open
Abstract
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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Affiliation(s)
- Ting Xia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Australia
| | - Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Australia
| | - Samanta Lalic
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
- Pharmacy Department, Monash Health, Clayton, Australia
| | - Rachelle Buchbinder
- Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, St Kilda, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Nadine E Andrew
- Peninsula Clinical School, Central Clinical School, Peninsula Health, Monash University, Frankston, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health, Richmond, Australia
| | | | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, 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 (Basel) 2023; 11:164. [PMID: 37888509 PMCID: PMC10609676 DOI: 10.3390/pharmacy11050164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Sturgiss E, Advocat J, Lam T, Nielsen S, Ball L, Gunatillaka N, Martin C, Barton C, Tam CWM, Skouteris H, Mazza D, Russell G. Multifaceted intervention to increase the delivery of alcohol brief interventions in primary care: a mixed-methods process analysis. Br J Gen Pract 2023; 73:e778-e788. [PMID: 37666514 PMCID: PMC10498380 DOI: 10.3399/bjgp.2022.0613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/23/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Brief interventions (BIs) are effective for reducing harmful alcohol consumption, but their use in primary care is less frequent than clinically indicated. The REducing AlCohol- related Harm (REACH) project aimed to increase the delivery of BIs in primary care. AIM To assess the effectiveness of the REACH programme in increasing alcohol BIs in general practice and explore the implementation factors that improve or reduce uptake by clinicians. DESIGN AND SETTING This article reports on a sequential, explanatory mixed-methods study of the implementation of the REACH project in six general practice clinics serving low-income communities in Melbourne, Australia. METHOD Time-series analyses were conducted using routinely collected patient records and semi-structured interviews, guided by the consolidated framework for implementation research. RESULTS The six intervention sites significantly increased their rate of recorded alcohol status (56.7% to 60.4%), whereas there was no significant change in the non-intervention practices (344 sites, 55.2% to 56.4%). CONCLUSION REACH resources were seen as useful and acceptable by clinicians and staff. National policies that support the involvement of primary care in alcohol harm reduction helped promote ongoing intervention sustainability.
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Affiliation(s)
- Elizabeth Sturgiss
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Jenny Advocat
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Tina Lam
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
| | - Lauren Ball
- Grad Dip Health Economics and Health Policy, chair of community health and wellbeing, University of Queensland, Brisbane, Australia; Menzies Health Institute Queensland and School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Nilakshi Gunatillaka
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Catherine Martin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Chun Wah Michael Tam
- Primary and Integrated Care Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia; conjoint senior lecturer, School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia; Warwick Business School, University of Warwick, Coventry, UK
| | | | - Grant Russell
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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McNeilage AG, Nielsen S, Murnion B, Ashton-James C. Experiences of misuse and symptoms of dependence among people who use gabapentinoids: a qualitative systematic review protocol. BMJ Open 2023; 13:e073770. [PMID: 37775298 PMCID: PMC10546131 DOI: 10.1136/bmjopen-2023-073770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/11/2023] [Indexed: 10/01/2023] Open
Abstract
INTRODUCTION Gabapentinoids are among the most widely prescribed pain medications. However, there is growing evidence to suggest that gabapentinoids may be associated with dependence and misuse. The aim of this systematic review is to synthesise the qualitative literature on gabapentinoid misuse and symptoms of dependence. The findings of this study will inform efforts to mitigate emerging harms. METHODS AND ANALYSIS A systematic review of qualitative research will explore lived experiences of misuse and symptoms of dependence among people who use gabapentinoids. Six databases (MEDLINE, Scopus, Web of Science, CINAHL, EMBASE and PsycINFO) and grey literature sources will be searched from inception to May 2023. Qualitative studies that include people with lived experiences of gabapentinoid misuse and symptoms of gabapentinoid dependence will be included. Reference lists of included studies will also be screened for additional studies. The methodological quality of included studies will be appraised using the Critical Appraisal Skills Programme qualitative checklist, and higher quality studies will be prioritised in the thematic synthesis. The GRADE-CERQual approach will be used to assess confidence in the overall findings of the review. ETHICS AND DISSEMINATION Ethical approval is not required for this systematic review. The findings of this review will be disseminated in peer-reviewed journals, at conferences and on social media. PROSPERO REGISTRATION NUMBER CRD42023401832.
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Affiliation(s)
- Amy Gray McNeilage
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
| | - Bridin Murnion
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Claire Ashton-James
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Roxburgh A, Livingston M, Dietze P, Nielsen S, Cogger S, Bartlett M, Day C, Latimer J, Jauncey M, Clark N. The impact of COVID-19 public health measures on attendance and overdose at supervised injecting facilities in Australia. Public Health 2023; 224:90-97. [PMID: 37742585 DOI: 10.1016/j.puhe.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/23/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES The COVID-19 pandemic disrupted service provision of harm reduction and drug treatment services for people who inject drugs in many countries. The two supervised injecting facilities (SIFs) in Sydney and Melbourne were differentially impacted by the pandemic, requiring local procedural changes in each service. We aimed to examine the impact of pandemic responses (including restrictions on movement, known as 'lockdowns') on service use and key parameters such as client reports of drug injected and recorded overdose rates. STUDY DESIGN Time series analysis of weekly client visits and monthly overdoses occurring at each service. METHODS Administrative client data from the two SIFs (Sydney data from 1 January 2018 to 30 April 2022; Melbourne data from 1 July 2018 to 30 April 2022) were examined using interrupted time series analyses with lockdown dates in each state entered as interruption terms. We analysed weekly SIF visits overall and by drug type, and monthly rates of opioid overdose at each service. RESULTS Lockdowns resulted in decreased visits to both services. The number of weekly client visits decreased during the first national lockdown for both the Sydney (trend change = -57.9; 95% CI [-109.4, -6.4]) and Melbourne SIF (near sig trend change = -54.8 [-110.8, 1.05]). Trends in visit numbers increased after lockdowns were lifted in each city; however, visits in Sydney have not returned to the numbers recorded prior to the pandemic. Visits to the Melbourne SIF related to heroin use declined at each lockdown (trend 1 = -42.7 [-81.5, -3.9]; trend 2 = -56.1 [-94.6, -17.7]; trend 3 = -33.8 [-67.4, -0.2]); heroin visits to the Sydney SIF declined during the first lockdown and remained low (trend = -55.6 [-82.8, -28.3]). Methamphetamine visits to the Sydney SIF fluctuated, surpassing heroin visits at several timepoints. Rates of monthly opioid overdoses at both services declined immediately following the start of the first lockdown (Sydney = -16.6 [-26.1, -6.8]; Melbourne = -6.4 [-8.7, -4.1]), with increasing trends recorded at the end of the final lockdown in each jurisdiction (Sydney = 2.8 [0.6, 5.0]; Melbourne = 1.3 [0.72, 3.2]). CONCLUSIONS Public health restrictions related to the COVID-19 pandemic were associated with reduced client visits to, and overdoses in, Australian SIFs. Variations were noted in the drugs injected, likely reflecting changes in local drug markets. Shifts to other drugs during these periods were evident: methamphetamine in Sydney; co-injection of heroin and diphenhydramine in Melbourne.
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Affiliation(s)
- A Roxburgh
- Harm and Risk Reduction Program, Burnet Institute, Melbourne, Australia; Specialty of Addiction Medicine, Central Clinical School, Sydney Medical School, The Faculty of Medicine and Health, University of Sydney, Sydney, Australia; National Drug and Alcohol Research Centre, UNSW, Sydney, Australia; Monash Addiction Research Centre, Monash University, Melbourne, Australia.
| | - M Livingston
- National Drug Research Institute, Curtin University, Perth, Australia
| | - P Dietze
- Harm and Risk Reduction Program, Burnet Institute, Melbourne, Australia; National Drug and Alcohol Research Centre, UNSW, Sydney, Australia; Monash Addiction Research Centre, Monash University, Melbourne, Australia; National Drug Research Institute, Curtin University, Perth, Australia
| | - S Nielsen
- Harm and Risk Reduction Program, Burnet Institute, Melbourne, Australia; National Drug and Alcohol Research Centre, UNSW, Sydney, Australia; Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - S Cogger
- North Richmond Community Health Medically Supervised Injecting Room, Melbourne Australia
| | - M Bartlett
- Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | - C Day
- Specialty of Addiction Medicine, Central Clinical School, Sydney Medical School, The Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | - J Latimer
- Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | - M Jauncey
- Specialty of Addiction Medicine, Central Clinical School, Sydney Medical School, The Faculty of Medicine and Health, University of Sydney, Sydney, Australia; National Drug and Alcohol Research Centre, UNSW, Sydney, Australia; Uniting Medically Supervised Injecting Centre, Sydney, Australia
| | - N Clark
- North Richmond Community Health Medically Supervised Injecting Room, Melbourne Australia; Addiction Medicine, Royal Melbourne Hospital, Melbourne, Australia
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Haines S, Savic M, Nielsen S, Carter A. Opioid-related policy changes: Experiences and perspectives from people who use opioids to manage non-cancer chronic pain. Drug Alcohol Rev 2023; 42:1482-1492. [PMID: 37254597 PMCID: PMC10946843 DOI: 10.1111/dar.13683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 06/01/2023]
Abstract
INTRODUCTION People who use prescription opioids to manage non-cancer chronic pain are particularly vulnerable to opioid-related policy change. This study aims to better understand what prescription opioids provide this population, what concerns they have in the context of new and changing opioid policies, such as the recently implemented prescription drug monitoring program in Victoria, Australia, their experiences of prescription opioid use, chronic pain and what they would like their healthcare to look like. METHODS Semi-structured interviews were conducted with 30 people who use opioids to manage chronic non-cancer pain. RESULTS Prescription opioids played an important role in supporting quality of life and mental health. However, experiences of stigma and lack of empathy from healthcare providers were common. Participants sought accurate information about their medications and expressed a desire for shared decision-making in healthcare. DISCUSSION AND CONCLUSION Prescription opioids can play an important role in pain management as well as social and psychological functioning for people living with non-cancer chronic pain. Opioid-related policy changes to medication availability need to consider the potential impacts that reducing, limiting or discontinuing opioids may have on this population. Including the voices of people who use prescription opioids to manage non-cancer chronic pain in respectful, compassionate and meaningful ways.
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Affiliation(s)
- Sarah Haines
- Turner Institute for Brain and Mental HealthMonash UniversityMelbourneAustralia
| | - Michael Savic
- Turning Point, Eastern HealthMelbourneAustralia
- Monash Addiction Research CentreMonash UniversityMelbourneAustralia
| | - Suzanne Nielsen
- Monash Addiction Research CentreMonash UniversityMelbourneAustralia
| | - Adrian Carter
- Turner Institute for Brain and Mental HealthMonash UniversityMelbourneAustralia
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Colledge-Frisby S, Rathnayake K, Nielsen S, Stoove M, Maher L, Agius PA, Higgs P, Dietze P. Injection Drug Use Frequency Before and After Take-Home Naloxone Training. JAMA Netw Open 2023; 6:e2327319. [PMID: 37540514 PMCID: PMC10403778 DOI: 10.1001/jamanetworkopen.2023.27319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/25/2023] [Indexed: 08/05/2023] Open
Abstract
Importance Concerns that take-home naloxone (THN) training may lead to riskier drug use (as a form of overdose risk compensation) remain a substantial barrier to training implementation. However, there was limited good-quality evidence in a systematic review of the association between THN access and subsequent risk compensation behaviors. Objective To assess whether THN training is associated with changes in overdose risk behaviors, indexed through injecting frequency, in a cohort of people who inject drugs. Design, Setting, and Participants This cohort study used prospectively collected self-reported behavioral data before and after THN training of participants in The Melbourne Injecting Drug User Cohort Study (SuperMIX). Annual interviews were conducted in and around Melbourne, Victoria, Australia, from 2008 to 2021. SuperMIX participants were adults who regularly injected heroin or methamphetamine in the 6 months preceding their baseline interview. The current study included only people who inject drugs who reported THN training and had participated in at least 1 interview before THN training. Exposure In 2017, the SuperMIX baseline or follow-up survey began asking participants if and when they had received THN training. The first THN training date that was recorded was included as the exposure variable. Subsequent participant interviews were excluded from analysis. Main Outcomes and Measures Injecting frequency was the primary outcome and was used as an indicator of overdose risk. Secondary outcomes were opioid injecting frequency, benzodiazepine use frequency, and the proportion of the time drugs were used alone. Fixed-effects generalized linear (Poisson) multilevel modeling was used to estimate the association between THN training and the primary and secondary outcomes. Time-varying covariates included housing status, income, time in study, recent opioid overdose, recent drug treatment, and needle and syringe coverage. Findings were expressed as incidence rate ratios (IRRs) with 95% CIs. Results There were 1328 participants (mean [SD] age, 32.4 [9.0] years; 893 men [67.2%]) who completed a baseline interview in the SuperMIX cohort, and 965 participants completed either a baseline or follow-up interview in or after 2017. Of these 965 participants, 390 (40.4%) reported THN training. A total of 189 people who inject drugs had pretraining participant interviews with data on injecting frequency and were included in the final analysis (mean [SD] number of interviews over the study period, 6.2 [2.2]). In fixed-effects regression analyses adjusted for covariates, there was no change in the frequency of injecting (IRR, 0.91; 95% CI, 0.69-1.20; P = .51), opioid injecting (IRR, 0.95; 95% CI, 0.74-1.23; P = .71), benzodiazepine use (IRR, 0.96; 95% CI, 0.69-1.33; P = .80), or the proportion of reported time of using drugs alone (IRR, 1.04; 95% CI, 0.86-1.26; P = .67) before and after THN training. Conclusions and Relevance This cohort study of people who inject drugs found no evidence of an increase in injecting frequency, along with other markers of overdose risk, after THN training and supply. The findings suggest that THN training should not be withheld because of concerns about risk compensation and that advocacy for availability and uptake of THN is required to address unprecedented opioid-associated mortality.
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Affiliation(s)
- Samantha Colledge-Frisby
- National Drug Research Institute, Curtin University, Melbourne, Victoria, Australia
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- National Drug and Alcohol Research Centre, University of New South Wales (UNSW) Sydney, Sydney, New South Wales, Australia
| | - Kasun Rathnayake
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Suzanne Nielsen
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- Monash Addiction Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Mark Stoove
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Lisa Maher
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Paul A. Agius
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- Faculty of Health, Deakin University, Melbourne, Victoria, Australia
| | - Peter Higgs
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
- Department of Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Paul Dietze
- National Drug Research Institute, Curtin University, Melbourne, Victoria, Australia
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
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Moullin JC, Ely P, Uren H, Staniland L, Nielsen S, Lenton S. Developing a single-session strategy for the implementation of take-home naloxone by community pharmacists using COM-B and design-thinking. Front Health Serv 2023; 3:1227360. [PMID: 37600924 PMCID: PMC10434522 DOI: 10.3389/frhs.2023.1227360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/14/2023] [Indexed: 08/22/2023]
Abstract
Background Despite the overwhelming evidence of its effectiveness, there is poor implementation of take-home naloxone by pharmacists. Barriers have been explored and mapped to the capability, opportunity, motivation-behaviour (COM-B) model of behaviour change, yet no theoretically informed implementation strategies that target known barriers have been developed. Single-session implementation strategies have been proposed as a simple, scalable way to target multiple barriers. Methods Qualitative participatory methods, incorporating design-thinking principles, were used to develop the key messages of a single-session implementation strategy. The key messages were drafted against COM-B mapped implementation barriers identified in the literature. A participatory workshop involving a pre-mortem exercise and incorporating design-thinking principles were used to refine the messages and generate methods for dissemination. Messages were mapped to interview questions to naturally illicit stories and delivered via storytelling from a pharmacist, a general practitioner, and a person with lived experience of using naloxone. Results A 3 minute 40 second video and a two-page printable infographic were developed and hosted on a website, with links to additional downloadable resources as a single-session implementation strategy. Email was the preferred method for receiving simple professional development communications, with social media also widely accessed. Discussion Implementation science, behavioural change theory, and participatory design methods are a complementary combination to develop implementation strategies. Some pharmacists questioned the participatory design approach to developing an implementation strategy, as it was outside of their comfort zone. However, the participatory process involving end-users resulted in unique ideas that are unlikely to have been generated using more traditional consultative approaches. The delivery as a single-session implementation strategy allows for widespread dissemination and delivery at scale.
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Affiliation(s)
- Joanna C. Moullin
- School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
- enAble Institute, Curtin University, Bentley, WA, Australia
| | - Philip Ely
- School of Design and the Built Environment, Faculty of Humanities, Curtin University, Bentley, WA, Australia
| | - Hannah Uren
- School of Population Health, Faculty of Health Sciences, Curtin University, Bentley, WA, Australia
| | - Lexy Staniland
- enAble Institute, Curtin University, Bentley, WA, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Frankston, VIC, Australia
| | - Simon Lenton
- enAble Institute, Curtin University, Bentley, WA, Australia
- National Drug Research Institute, Curtin University, Bentley, WA, Australia
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Berg A, Francia L, Lam T, Morgan K, Lubman DI, Nielsen S. Enriching qualitative alcohol and other drug research by engaging lived experience peer researchers in a dual-interview approach: A case study. Drug Alcohol Rev 2023. [PMID: 37503834 DOI: 10.1111/dar.13724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/19/2023] [Accepted: 06/29/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Engaging people with lived experience of alcohol and other drug use as peer researchers in qualitative research is becoming more common. However, there are differing opinions on how to best engage and support peer researchers. CASE PRESENTATION Through this case study the researchers aimed to illustrate the potential benefits of a peer/academic researcher dual-interview approach as a qualitative method in research. In the study, a peer researcher who had lived experience of alcohol and other drug use collaborated with an academic researcher who had qualitative expertise. Semi-structured interviews (N = 22) were undertaken with men and women with lived experience of alcohol and other drug harms (n = 14) and healthcare staff (n = 8) from alcohol and other drug, and broader healthcare services. DISCUSSION AND CONCLUSIONS The research team contend that in a dual-interview approach, rather than peer/academic researchers being binary opposites, there exists a continuum along which peer and academic researchers travel back and forth; that supports recognition of similarities and differences; and deepens mutual respect. Engaging peer researchers also represents an opportunity for meaningful capability building, with the ultimate and important goal of having peer researchers drive their own research agendas, and move from supporting to leading alcohol and other drug-related research.
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Affiliation(s)
- Amelia Berg
- Association of Participating Services Users, Self Help Addiction Resource Centre, Melbourne, Australia
| | - Leanne Francia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Tina Lam
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
- National Centre for Healthy Ageing, Monash University and Peninsula Health, Melbourne, Australia
| | | | - Dan I Lubman
- Turning Point, Eastern Health and Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
- National Centre for Healthy Ageing, Monash University and Peninsula Health, Melbourne, Australia
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Langford AV, Lin CC, Bero L, Blyth FM, Doctor J, Holliday S, Jeon YH, Moullin J, Murnion B, Nielsen S, Osman R, Penm J, Reeve E, Reid S, Wale J, Schneider CR, Gnjidic D. Clinical practice guideline for deprescribing opioid analgesics: summary of recommendations. Med J Aust 2023; 219:80-89. [PMID: 37356051 DOI: 10.5694/mja2.52002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 06/27/2023]
Abstract
INTRODUCTION Long term opioids are commonly prescribed to manage pain. Dose reduction or discontinuation (deprescribing) can be challenging, even when the potential harms of continuation outweigh the perceived benefits. The Evidence-based clinical practice guideline for deprescribing opioid analgesics was developed using robust guideline development processes and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, and contains deprescribing recommendations for adults prescribed opioids for pain. MAIN RECOMMENDATIONS Eleven recommendations provide advice about when, how and for whom opioid deprescribing should be considered, while noting the need to consider each person's goals, values and preferences. The recommendations aim to achieve: implementation of a deprescribing plan at the point of opioid initiation; initiation of opioid deprescribing for persons with chronic non-cancer or chronic cancer-survivor pain if there is a lack of overall and clinically meaningful improvement in function, quality of life or pain, a lack of progress towards meeting agreed therapeutic goals, or the person is experiencing serious or intolerable opioid-related adverse effects; gradual and individualised deprescribing, with regular monitoring and review; consideration of opioid deprescribing for individuals at high risk of opioid-related harms; avoidance of opioid deprescribing for persons nearing the end of life unless clinically indicated; avoidance of opioid deprescribing for persons with a severe opioid use disorder, with the initiation of evidence-based care, such as medication-assisted treatment of opioid use disorder; and use of evidence-based co-interventions to facilitate deprescribing, including interdisciplinary, multidisciplinary or multimodal care. CHANGES IN MANAGEMENT AS A RESULT OF THESE GUIDELINES To our knowledge, these are the first evidence-based guidelines for opioid deprescribing. The recommendations intend to facilitate safe and effective deprescribing to improve the quality of care for persons taking opioids for pain.
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Affiliation(s)
- Aili V Langford
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC
- University of Sydney, Sydney, NSW
| | - Christine Cw Lin
- Institute for Musculoskeletal Health, University of Sydney, Sydney, NSW
| | - Lisa Bero
- Center for Bioethics and Humanities, University of Colorado, Aurora (CO), USA
| | | | - Jason Doctor
- University of Southern California, Los Angeles (CA), USA
| | | | | | | | - Bridin Murnion
- University of Sydney, Sydney, NSW
- Western Sydney Local Health District, Sydney, NSW
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Melbourne, VIC
| | | | - Jonathan Penm
- University of Sydney, Sydney, NSW
- Prince of Wales Hospital and Community Health Services, Sydney, NSW
| | - Emily Reeve
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC
- University of South Australia, Adelaide, SA
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Nawaz A, Nielsen S, Mehmood T, Abdullah A, Ahmed A, Ullah W, Khan A. Prescription drug dependence with and without concurrent illicit drug use: a multicenter cross-sectional survey among an addiction treatment seeking population. Front Psychiatry 2023; 14:1133606. [PMID: 37324815 PMCID: PMC10267420 DOI: 10.3389/fpsyt.2023.1133606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
Background Dependence on prescription drugs and illicit drugs imposes a global health and social burden. Despite accumulating evidence of prescription drugs and illicit drugs dependence, none of the systematized studies has explored the magnitude of this problem in Pakistan. The aim is to investigate the extent and associated factors of prescription drug dependence (PDD), as opposed to concomitant prescription drug dependence and illicit drug use (PIDU), within a sample of individuals seeking addiction treatment. Methods The cross sectional study was conducted on the sample recruited from three drug treatment centers in Pakistan. Face-to-face interviews were conducted with participants who met ICD-10 criteria for prescription drug dependence. Several aspects like substance use histories, negative health outcomes, patient attitude, pharmacy and physician practices also collected to predict the determinants of (PDD). Binomial logistic regression models examined the factors associated with PDD and PIDU. Results Of the 537 treatment seeking individuals interviewed at baseline, close to one third (178, 33.3%) met criteria for dependence on prescription drugs. The majority of the participants were male (93.3%), average age of 31 years, having urban residence (67.4%). Among participants who met criteria for dependence on prescription drugs (71.9%), reported benzodiazepines as the most frequently used drug, followed by narcotic analgesics (56.8%), cannabis/marijuana (45.5%), and heroin (41.5%). The patients reported alprazolam, buprenorphine, nalbuphine, and pentazocin use as alternatives to illicit drugs. PDD was significantly negatively associated with injectable route (OR = 0.281, 95% CI, 0.079-0.993) and psychotic symptoms (OR = 0.315, 95% CI, 0.100, 0.986). This implies that PDD is less likely to be associated with an injectable route and psychotic symptoms in contrast to PIDU. Pain, depression and sleep disorder were primary reasons for PDD. PDD was associated with the attitude that prescription drugs are safer than illicit drugs (OR = 4.057, 95%CI, 1.254-13.122) and PDD was associated with being on professional terms (i.e., having an established relationship) with pharmaceutical drugs retailers for acquisition of prescription drugs. Discussion and conclusion The study found benzodiazepine and opioid dependence in sub sample of addiction treatment seekers. The results have implications for drug policy and intervention strategies for preventing and treating drug use disorders.
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Affiliation(s)
- Asma Nawaz
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Tahir Mehmood
- School of Natural Sciences, National University of Science and Technology, Islamabad, Pakistan
| | | | - Ali Ahmed
- School of Pharmacy, Monash University, Bandar Sunway, Selangor, Malaysia
| | - Waseem Ullah
- Department of Pharmacy Practice, Shifa College of Pharmaceutical Sciences, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Ahmad Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
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Degenhardt L, Clark B, Macpherson G, Leppan O, Nielsen S, Zahra E, Larance B, Kimber J, Martino-Burke D, Hickman M, Farrell M. Buprenorphine versus methadone for the treatment of opioid dependence: a systematic review and meta-analysis of randomised and observational studies. Lancet Psychiatry 2023; 10:386-402. [PMID: 37167985 DOI: 10.1016/s2215-0366(23)00095-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Opioid dependence is associated with substantial health and social burdens, and opioid agonist treatment (OAT) is highly effective in improving multiple outcomes for people who receive this treatment. Methadone and buprenorphine are common medications provided as OAT. We aimed to examine buprenorphine compared with methadone in the treatment of opioid dependence across a wide range of primary and secondary outcomes. METHODS We did a systematic review and meta-analysis in accordance with GATHER and PRISMA guidelines. We searched Embase, MEDLINE, CENTRAL, and PsycINFO from database inception to Aug 1, 2022; clinical trial registries and previous relevant Cochrane reviews were also reviewed. We included all RCTs and observational studies of adults (aged ≥18 years) with opioid dependence comparing treatment with buprenorphine or methadone. Primary outcomes were retention in treatment at 1, 3, 6, 12, and 24 months, treatment adherence (measured through doses taken as prescribed, dosing visits attended, and biological measures), or extra-medical opioid use (measured by urinalysis and self-report). Secondary outcomes were use of benzodiazepines, cannabis, cocaine, amphetamines, and alcohol; withdrawal; craving; criminal activity and engagement with the criminal justice system; overdose; mental and physical health; sleep; pain; global functioning; suicidality and self-harm; and adverse events. Single-arm cohort studies and RCTs that collected data on buprenorphine retention alone were also reviewed. Data on study, participant, and treatment characteristics were extracted. Study authors were contacted to obtain additional data when required. Comparative estimates were pooled with use of random-effects meta-analyses. The proportion of individuals retained in treatment across multiple timepoints was pooled for each drug. This study is registered with PROSPERO (CRD42020205109). FINDINGS We identified 32 eligible RCTs (N=5808 participants) and 69 observational studies (N=323 340) comparing buprenorphine and methadone, in addition to 51 RCTs (N=11 644) and 124 observational studies (N=700 035) that reported on treatment retention with buprenorphine. Overall, 61 studies were done in western Europe, 162 in North America, 14 in north Africa and the Middle East, 20 in Australasia, five in southeast Asia, seven in south Asia, two in eastern Europe, three in central Europe, one in east Asia, and one in central Asia. 1 040 827 participants were included in these primary studies; however, gender was only reported for 572 111 participants, of whom 377 991 (66·1%) were male and 194 120 (33·9%) were female. Mean age was 37·1 years (SD 6·0). At timepoints beyond 1 month, retention was better for methadone than for buprenorphine: for example, at 6 months, the pooled effect favoured methadone in RCTs (risk ratio 0·76 [95% CI 0·67-0·85]; I·=74·2%; 16 studies, N=3151) and in observational studies (0·77 [0·68-0·86]; I·=98·5%; 21 studies, N=155 111). Retention was generally higher in RCTs than observational studies. There was no evidence suggesting that adherence to treatment differed with buprenorphine compared with methadone. There was some evidence that extra-medical opioid use was lower in those receiving buprenorphine in RCTs that measured this outcome by urinalysis and reported proportion of positive urine samples (over various time frames; standardised mean difference -0·20 [-0·29 to -0·11]; I·=0·0%; three studies, N=841), but no differences were found when using other measures. Some statistically significant differences were found between buprenorphine and methadone among secondary outcomes. There was evidence of reduced cocaine use, cravings, anxiety, and cardiac dysfunction, as well as increased treatment satisfaction among people receiving buprenorphine compared with methadone; and evidence of reduced hospitalisation and alcohol use in people receiving methadone. These differences in secondary outcomes were based on small numbers of studies (maximum five), and were often not consistent across study types or different measures of the same constructs (eg, cocaine use). INTERPRETATION Evidence from trials and observational studies suggest that treatment retention is better for methadone than for sublingual buprenorphine. Comparative evidence on other outcomes examined showed few statistically significant differences and was generally based on small numbers of studies. These findings highlight the imperative for interventions to improve retention, consideration of client-centred factors (such as client preference) when selecting between methadone and buprenorphine, and harmonisation of data collection and reporting to strengthen future syntheses. FUNDING Australian National Health and Medical Research Council.
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Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
| | - Brodie Clark
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Georgina Macpherson
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Oscar Leppan
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Melbourne, VIC, Australia
| | - Emma Zahra
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Briony Larance
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Jo Kimber
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Daniel Martino-Burke
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Matthew Hickman
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
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Nielsen S, Picco L, Russell G, Pearce C, Andrew NE, Lubman DI, Bell JS, Buchbinder R, Xia T. Changes in opioid and other analgesic prescribing following voluntary and mandatory prescription drug monitoring program implementation: A time series analysis of early outcomes. Int J Drug Policy 2023; 117:104053. [PMID: 37209441 DOI: 10.1016/j.drugpo.2023.104053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/17/2023] [Accepted: 04/28/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Australian prescription drug monitoring programs (PDMPs) provide information about a patient's recent medication history for controlled drugs at the point of prescribing and dispensing. Despite their increasing use, the evidence for PDMPs is mixed, and is almost exclusively from the United States. This study examined the impact of PDMP implementation on opioid prescribing among general practitioners in Victoria, Australia. METHOD We examined data on analgesic prescribing using electronic records of 464 medical practices in the Australian state of Victoria between 01/04/2017 and 31/12/ 2020. We used interrupted time series analyses, to examine immediate and longer-term trends in medication prescribing following voluntary (from April 2019) and mandatory PDMP implementation (from April 2020). We examined changes in three outcomes (i) 'high' opioid dose (50-100mg oral morphine equivalent daily dose (OMEDD) and over 100mg (OMEDD) prescribing (ii) prescribing of high-risk medication combinations (opioids with either benzodiazepines or pregabalin), and (iii) initiation of non-controlled pain medications (tricyclic antidepressants, pregabalin and tramadol). RESULTS We found no effect of voluntary or mandatory PDMP implementation on 'high-dose' opioid prescribing with reductions only seen in those prescribed <20mg OMEDD (i.e., the lowest dose category). Co-prescribing of opioids with benzodiazepines (additional 11.87 [95%CI 2.04 to 21.67] patients/10,000 and pregabalin (additional 3.54 [95% CI 0.82 to 6.26] patients/10,000 increased following mandatory PDMP implementation among those prescribed opioids. In contrast to trends of reduced initiation prior to PDMP implementation, we found increased new initiation of non-monitored medications following PDMP implementation (e.g., an immediate increase of 2.32 [95%CI 0.02 to 4.54], patients/10,000 received pregabalin and 3.06 [95%CI 0.54 to 5.5] patients/10,000 received tricyclic antidepressants after mandatory PDMP implementation), and increased tramadol initiation during the voluntary PDMP period (an increase of 11.26 [95%CI: 5.84, 16.67] patients /10,000). CONCLUSION PDMP implementation did not appear to reduce prescribing of high opioid doses or high-risk combinations. Increased initiation of tricyclic antidepressants, pregabalin and tramadol may indicate a possible unintended effect.
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Affiliation(s)
- Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia.
| | - Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Grant Russell
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Nadine E Andrew
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia; National Centre for Healthy Ageing, Melbourne, Australia
| | - Dan I Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ting Xia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
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Nielsen S, Buchbinder R, Pearce C, Lubman D, Lalic S, Haas R, Picco L, Jung M, Cangadis-Douglass H, Ilomaki J, Bell JS, Xia T. Cohort profile: Using primary care data to understand Opioid Prescribing, Policy Impacts and Clinical Outcomes (OPPICO) in Victoria, Australia. BMJ Open 2023; 13:e067746. [PMID: 37130678 PMCID: PMC10163530 DOI: 10.1136/bmjopen-2022-067746] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
PURPOSE The OPPICO cohort is a population-based cohort based on non-identifiable electronic health records routinely collected from 464 general practices in Victoria, Australia, created with the aim of understanding opioid prescribing, policy impacts and clinical outcomes. The aim of this paper is to provide a profile of the study cohort by summarising available demographic, clinical and prescribing characteristics. PARTICIPANTS The cohort described in this paper comprises people who were aged at least 14 years at cohort entry, and who were prescribed an opioid analgesic at least once at participating practices for a total of 1 137 728 person-years from 1 January 2015 to 31 December 2020. The cohort was formed using the data collected from electronic health records through the Population Level Analysis and Reporting (POLAR) system. The POLAR data primarily consist of patient demographics, clinical measurements, Australian Medicare Benefits Scheme item numbers, diagnoses, pathology testing and prescribed medications. FINDING TO DATE In total, the cohort consists of 676 970 participants with 4 389 185 opioid prescription records from 1 January 2015 to 31 December 2020. Approximately half (48.7%) received a single opioid prescription, and 0.9% received more than 100 opioid prescriptions. The mean number of opioid prescriptions per patient was 6.5 (SD=20.9); prescriptions for strong opioids accounted for 55.6% of all opioid prescriptions. FUTURE PLANS The OPPICO cohort data will be used for various types of pharmacoepidemiological research, including examining the impact of policy changes on coprescription of opioids with benzodiazepines and gabapentin, and monitoring trends and patterns of other medication utilisation. Through data-linkage between our OPPICO cohort and hospital outcome data, we will examine whether policy changes for opioid prescribing lead to changes in prescription opioid-related harms, and other drug and mental health-related outcomes. TRIAL REGISTRATION NUMBER EU PAS Register (EUPAS43218, prospectively registered).
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Affiliation(s)
- Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
| | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Dan Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
- Turning Point, Eastern Health, Richmond, Victoria, Australia
| | - Samanta Lalic
- Centre for Medicine Use and Safety, Facultuy of Pharmacy and Pharmaceutical Sciences, Parkville, Victoria, Australia
| | - Romi Haas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
| | - Monica Jung
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
- Centre for Medicine Use and Safety, Facultuy of Pharmacy and Pharmaceutical Sciences, Parkville, Victoria, Australia
| | - Helena Cangadis-Douglass
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
- Centre for Medicine Use and Safety, Facultuy of Pharmacy and Pharmaceutical Sciences, Parkville, Victoria, Australia
| | - Jenni Ilomaki
- Centre for Medicine Use and Safety, Facultuy of Pharmacy and Pharmaceutical Sciences, Parkville, Victoria, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Facultuy of Pharmacy and Pharmaceutical Sciences, Parkville, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ting Xia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
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Morgan K, Solomon LM, Jones N, Picco L, Nielsen S. Building knowledge in opioid prescribing in post-operative treatment. Int J Pharm Pract 2023:7142871. [PMID: 37186142 DOI: 10.1093/ijpp/riad024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 04/02/2023] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Opioids prescribed in hospital are a key risk factor for harm in the community. This study aimed to gain an in-depth understanding of factors affecting post-operative opioid prescribing amongst clinicians using the capability, opportunity, motivation generate behaviour framework, more commonly known as COM-B. METHODS Focus groups and semi-structured interviews were used to gain an in-depth understanding of factors affecting optimal practice when prescribing opioids for post-operative patients at discharge. A topic guide was written using the COM-B behaviour change model to ensure the full range of possible factors influencing prescribing behaviours were explored. RESULTS We found barriers and facilitators of optimal opioid prescribing practice across all three domains of capability, opportunity and motivation. Capability among junior doctors could be increased in the areas of risk assessment and prescribing appropriate discharge analgesia, though education and training were not key barriers to improving practice. Findings indicated that opportunity to practice optimal prescribing was hindered by a lack of time at discharge and technology. Beliefs about one's own and others' responsibilities also impacted motivation to practice optimal prescribing behaviours. Pharmacists were identified as key supports for patient education and appropriate prescribing. CONCLUSIONS Educating prescribers about opioid risks and clinical practice guidelines are necessary interventions, however, our findings indicate that if implemented in isolation, they may not have the desired impact. Interventions also need to address discharge time pressures and presumptions that GPs are aware of whether opioids should be ceased or continued after surgical discharge.
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Affiliation(s)
- Kirsty Morgan
- Peninsula Health, Frankston, Victoria, Australia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, Australia
| | | | | | - Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, Australia
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Francia L, Lam T, Berg A, Morgan K, Savic M, Lubman Am DI, Nielsen S. Alcohol and other drug use: A qualitative exploration of staff and patient's experiences of language use as a means of stigma communication in hospital and primary care settings. J Subst Use Addict Treat 2023; 149:209050. [PMID: 37086790 DOI: 10.1016/j.josat.2023.209050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/21/2022] [Accepted: 04/13/2023] [Indexed: 04/24/2023]
Abstract
INTRODUCTION The hospital and primary care settings present opportunities to interact, initiate conversations, and instigate referrals for patients experiencing harm from their alcohol and other drug use. Using a stigma communication model, our qualitative study explored whether stigma communication materialized in staff's language in the hospital and primary care settings, and if so, whether this had any impact on staff's and patients' experiences. METHOD The study conducted thematic analysis on 39 semi-structured interviews comprising both male and female adults (n = 20) who had experienced or were currently experiencing problematic alcohol or other drug use; and staff (n = 19) from either alcohol and other drug specialist services, or other broader health care services. RESULTS The study identified three themes where language use materialized as a means of stigma communication: (i) language that positioned a patient as undeserving; (ii) language that separated a patient from other patients; and (iii) language that blamed a patient. Where language use materialized as a means of stigma communication, this appeared to influence staff's decision-making, or potential avoidance of staff's obligations related to health care. Where language use materialized as a means of stigma communication for patients, poor experiences occurred for both staff and patients, that potentially influenced health care provision and future treatment-seeking intentions. CONCLUSIONS The use of language as a means of stigma communication was present in staff/patient interactions. Although a number of targeted interventions exist that address language and stigma toward people who use alcohol and other drugs, our findings indicate that change may be inhibited if staff do not realize that their own use of language may contribute to the perpetuation of stigma. The findings also suggest that aspects of language that materialize as a means of stigma communication may impact the "no wrong door" approach, which intends that people, regardless of which service they attend, receive appropriate support.
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Affiliation(s)
- Leanne Francia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia.
| | - Tina Lam
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
| | - Amelia Berg
- Association of Participating Services Users, Self Help Addiction Resource Centre, 140 Grange Road, Carnegie, VIC 2063, Australia
| | - Kirsty Morgan
- Peninsula Health, 2 Hastings Road, Frankston, VIC 3199, Australia
| | - Michael Savic
- Eastern Health Clinical School, Turning Point, Richmond, Victoria 3121, Australia
| | - Dan I Lubman Am
- Eastern Health Clinical School, Turning Point, Richmond, Victoria 3121, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, Victoria, Australia
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Nielsen S, Barratt M, Hiley S, Bartlett M, Latimer J, Jauncey M, Roux C, Morelato M, Clark N, Kowalski M, Gilbert M, Francia L, Shipton A, Gerostamoulos D, Glowacki L, Lam T. Monitoring for fentanyl within Australian supervised injecting facilities: Findings from feasibility testing of novel methods and collaborative workshops. Int J Drug Policy 2023; 115:104015. [PMID: 37043848 DOI: 10.1016/j.drugpo.2023.104015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/31/2023] [Accepted: 03/18/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Australia is yet to see widespread fentanyl-contaminated heroin, despite the established presence of fentanyl in other countries. International mortality trends alongside a local cluster of fentanyl-related deaths prompted interest in developing methods to monitor for fentanyl and other potentially harmful novel psychoactive substances (NPS) in Australia. METHODS We tested novel methods to monitor for fentanyl and other NPS. From 2017-2021, clients from supervised injecting facilities (SIFs) in Melbourne and Sydney, Australia, contributed urine screens (UDS) with BTNX Rapid Response™ fentanyl test strips (FTS) paired with surveys, and injecting equipment associated with opioid overdoses for laboratory analysis. A single site piloted drug checking using FTS with laboratory confirmation. Two workshops were conducted with SIF staff, content experts and people with lived experience to determine how results can inform practices within SIFs. RESULTS Of the 911 UDS with FTS conducted, less than 1% (n=8) yielded positive results that were not explained by self-reported pharmaceutical fentanyl use, with two laboratory confirmed fentanyl positive results. Injecting equipment from 59 overdoses was tested and neither fentanyl nor other NPS were identified. Drug checking with FTS (n=34) indicated the presence of fentanyl on three tests. Two specimens were subsequently sent for laboratory testing and classified as false positives as the presence of fentanyl was not confirmed. Workshop participants (n=21) felt routine monitoring with FTS currently had limited value. A process for using pre-defined signals to trigger surveillance was developed. CONCLUSION The high false positive rates with FTS, relative to the small number of positive results and potential for them to undermine confidence in FTS emphasised the need for confirmatory testing. The role of routine surveillance was unclear within the current low-fentanyl context, however, a process was developed to upscale testing should signals of increased fentanyl prevalence in the Australian heroin market emerge.
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Affiliation(s)
- Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Peninsula Campus. Moorooduc Hwy, VIC, Australia; National Drug and Alcohol Research Centre, UNSW Sydney, NSW, Australia.
| | - Monica Barratt
- National Drug and Alcohol Research Centre, UNSW Sydney, NSW, Australia; Social and Global Studies Centre and Digital Ethnography Research Centre, RMIT University, Melbourne, VIC, Australia
| | - Sarah Hiley
- Medically Supervised Injecting Room, North Richmond Community Health, VIC, Australia
| | - Mark Bartlett
- Uniting Medically Supervised Injecting Centre, Sydney, NSW, Australia
| | - Julie Latimer
- Uniting Medically Supervised Injecting Centre, Sydney, NSW, Australia
| | - Marianne Jauncey
- Uniting Medically Supervised Injecting Centre, Sydney, NSW, Australia
| | - Claude Roux
- Centre for Forensic Science, University of Technology Sydney, NSW, Australia
| | - Marie Morelato
- Centre for Forensic Science, University of Technology Sydney, NSW, Australia
| | - Nico Clark
- Medically Supervised Injecting Room, North Richmond Community Health, VIC, Australia
| | | | | | - Leanne Francia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Peninsula Campus. Moorooduc Hwy, VIC, Australia
| | - Alexandra Shipton
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Peninsula Campus. Moorooduc Hwy, VIC, Australia
| | - Dimitri Gerostamoulos
- Victorian Institute of Forensic Medicine, Southbank, VIC, Australia; Department of Forensic Medicine, Monash University, VIC, Australia
| | - Linda Glowacki
- Victorian Institute of Forensic Medicine, Southbank, VIC, Australia
| | - Tina Lam
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Peninsula Campus. Moorooduc Hwy, VIC, Australia
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Picco L, Ritter A, Nielsen S. Prescription drug monitoring programs in Australia: A call for a comprehensive evaluation. Drug Alcohol Rev 2023; 42:745-747. [PMID: 37014802 DOI: 10.1111/dar.13652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 04/05/2023]
Affiliation(s)
- Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Alison Ritter
- Drug Policy Modelling Program, Social Policy Research Centre, UNSW Sydney, Sydney, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
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Lam T, Xia T, Biggs N, Treloar M, Cheng O, Kabu K, Stevens JA, Evans JD, da Gama ME, Lubman DI, Nielsen S. Effect of discharge opioid on persistent postoperative opioid use: a retrospective cohort study comparing tapentadol with oxycodone. Anaesthesia 2023; 78:420-431. [PMID: 36535726 DOI: 10.1111/anae.15933] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 12/24/2022]
Abstract
Opioid harm can vary by opioid type. This observational study examined the effect of opioid type (oxycodone vs. tapentadol) on rates of persistent postoperative opioid use ('persistence'). We linked hospital and community pharmacy data for surgical patients who were dispensed discharge opioids between 1 January 2016 and 30 September 2021. Patients were grouped by opioid experience ('opioid-naive' having received no opioids in the 3 months before discharge) and formulation of discharge opioid (immediate release only or modified release ± immediate release). Mixed-effects logistic regression models predicted persistence (continued use of any opioid at 90 days after discharge), controlling for key persistence risk factors. Of the 122,836 patients, 2.31% opioid-naive and 27.24% opioid-experienced patients met the criteria for persistence. For opioid-naive patients receiving immediate release opioids, there was no significant effect of opioid type. Tapentadol modified release was associated with significantly lower odds of persistence compared with oxycodone modified release, OR (95%CI) 0.81 (0.69-0.94) for opioid-naive patients and 0.81 (0.71-0.93) for opioid-experienced patients. Among patients who underwent orthopaedic surgery (n = 19,832), regardless of opioid experience or opioid formulation, the odds of persistence were significantly lower for those who received tapentadol compared with oxycodone. This was one of the largest and most extensive studies of persistent postoperative opioid use, and the first that specifically examined persistence with tapentadol. There appeared to be lower odds of persistence for tapentadol compared with oxycodone among key subgroups, including patients prescribed modified release opioids and those undergoing orthopaedic surgery.
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Affiliation(s)
- T Lam
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, VIC, Australia
| | - T Xia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Frankston, VIC, Australia
| | - N Biggs
- NostraData, Kew, VIC, Australia
| | | | - O Cheng
- IQVIA, St Leonards, NSW, Australia
| | - K Kabu
- IQVIA, St Leonards, NSW, Australia
| | - J A Stevens
- St Vincent's Clinical School, UNSW Medicine, Darlinghurst, NSW, Australia
| | - J D Evans
- Slade Pharmacy, Mount Waverley, VIC, Australia
| | | | - D I Lubman
- Monash Addiction Research Centre, Turning Point, Eastern Health Clinical School, Monash University, Frankston, Richmond, VIC, Australia
| | - S Nielsen
- Monash Addiction Research Centre, Turning Point, Eastern Health Clinical School, Monash University, Frankston, Richmond, VIC, Australia
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Picco L, Lam T, Xia T, Nielsen S. Factors associated with prescription drug monitoring program utilisation: a cross-sectional survey of community pharmacists. Int J Clin Pharm 2023; 45:421-429. [PMID: 36528707 PMCID: PMC9759276 DOI: 10.1007/s11096-022-01523-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/18/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Prescription drug monitoring programs (PDMP) are databases which collect prescribing and dispensing information for high-risk medicines, and are one approach to mitigate prescription opioid-related risks. AIM To examine correlates of PDMP use under voluntary and mandatory conditions, among a representative sample of community pharmacists in Victoria, Australia. METHOD An online anonymous survey was conducted and collected data in relation to pharmacist and pharmacy characteristics, comfort in performing certain tasks, PDMP training and the frequency of PDMP use under voluntary and mandatory conditions. Multivariate logistic regression models were performed to determine the effect of each covariate on voluntary and mandatory PDMP use. RESULTS In total, 265 pharmacists participated (response rate 47%). Under voluntary conditions, a quarter of pharmacists (24.9%) used the PDMP all the time, while half (51.7%) used the PDMP all of the time, once mandated. Pharmacies that stocked naloxone (OR: 1.96; 95% CI 1.11-3.45) and pharmacists that had attended formal PDMP training (OR: 1.78; 95% CI 1.05-3.05), were significantly associated with regular PDMP use under voluntary conditions. Under mandatory conditions, increased odds of PDMP use were associated with pharmacies that stocked naloxone (OR: 1.88; 95% CI 1.06-3.34). Pharmacists working in regional and rural areas had significantly lower odds (OR: 0.35; 95% CI 0.20-0.63) of always using the PDMP, as did pharmacists with > 15 years' experience (OR: 0.24; 95% CI 0.11-0.51) once use was mandated. CONCLUSION Given that PDMP utilisation was slower or less regular amongst pharmacists located in regional and rural areas, pharmacists with more years of experience and those not already supplying naloxone, targeted training aimed at these sub-populations may be beneficial.
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Affiliation(s)
- Louisa Picco
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia.
| | - Tina Lam
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia
| | - Ting Xia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, 47-49 Moorooduc Hwy, Frankston, VIC, 3199, Australia
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Lam T, Callinan S, Nielsen S, Horn F, Francia L, Vandenberg B. Which alcohol products might be affected by the introduction of a minimum unit price in Western Australia? Findings from a survey of alcohol retail prices. Drug Alcohol Rev 2023; 42:915-925. [PMID: 36895150 DOI: 10.1111/dar.13638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 12/12/2022] [Accepted: 02/14/2023] [Indexed: 03/11/2023]
Abstract
INTRODUCTION Minimum unit price (MUP) policies establish a retail floor price below which alcohol may not be sold, and have been shown to reduce harmful alcohol use. We aimed to collect retail price data to estimate the proportion of alcohol products that would potentially be impacted by a MUP policy in Western Australia. METHODS We purposively sampled the four largest off-premises alcohol retail chains, a further random sample of other off-premise alcohol outlets (n = 16) and on-premise inner-city outlets (n = 11). Using website data from May to June 2021, we estimated the proportion of products across four beverage categories priced ≤A$1.30, ≤A$1.50 and ≤A$1.75 per standard drink (10 g alcohol). RESULTS Of 27,797 off-premise products identified, 5.7% were available at ≤$1.30 per standard drink, 7.6% at ≤$1.50 and 10.4% at ≤$1.75. The proportion of products available at ≤$1.30 per standard drink varied by beverage category: 7.8% wine, 2.9% beer and cider, <0.1% spirits, 0.0% ready-to-drink spirits. Cask-packaged wines represented only 1.9% of off-premise wine products and 98.9% of this cask wine was priced ≤$1.30 per standard drink. No on-premise products were priced ≤$1.75 per standard drink. DISCUSSION AND CONCLUSIONS A comprehensive survey of alcohol prices in Western Australia found only a small proportion of products would potentially be affected by a MUP of $1.30 to $1.75 per standard drink. A MUP policy has potential to target the small proportion of alcohol products available at very low prices (i.e., off-premise cask wine), with negligible impact on other off-premise beverage categories, and no impact on on-premises products.
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Affiliation(s)
- Tina Lam
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Sarah Callinan
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Freya Horn
- Turning Point, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Leanne Francia
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Brian Vandenberg
- School of Social Sciences, Monash University, Melbourne, Australia
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Cheetham A, Morgan K, Jackson J, Lord S, Nielsen S. Informing a collaborative-care model for delivering medication assisted treatment for opioid dependence (MATOD): An analysis of pharmacist, prescriber and patient perceptions. Res Social Adm Pharm 2023; 19:526-534. [PMID: 36216753 DOI: 10.1016/j.sapharm.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Demand for medication assisted treatment for opioid dependence (MATOD) in Australia exceeds capacity, particularly in rural and regional areas. There is increasing recognition that community pharmacists are well-positioned to take on expanded roles in MATOD delivery, however there has been limited Australian research exploring attitudes of pharmacists, prescribers, and patients to collaborative models of care. OBJECTIVE(S) This study aimed to better understand enablers and barriers to a collaborative model for MATOD, to inform implementation in regions where increases in treatment capacity are urgently needed. METHODS Semi-structured telephone interviews were conducted with pharmacists (n = 11), prescribers (n = 6), and patients (n = 8) recruited from the Frankston-Mornington Peninsula region in Victoria, Australia, where transport and access to services have impacts on health care utilisation. The COM-B model was used to explore perceptions of pharmacists' capability, opportunity, and motivations for delivering collaborative care. RESULTS There was strong motivation among healthcare professionals to participate in a collaborative model of care, with the main perceived benefits including improvements in accessibility, convenience, and continuity of care, and leverage of pharmacists' high level of patient engagement. Key barriers identified by both pharmacists and prescribers included a perceived lack of pharmacist skills in some areas (capability) and resources (opportunity) to deliver collaborative care in a community pharmacy setting. Established relationships between all stakeholders (social opportunity) and communication between pharmacists and prescribers were identified as facilitators. Barriers and facilitators aligned with seven key areas: skills, confidence, relationships, patient selection, protocols, communication and resources. CONCLUSIONS Findings informed the development of a collaborative model that was individualised, protocol based, and supported by training and clear processes. PROJECT IMPACT This study identifies specific barriers and facilitators to a pharmacist-prescriber collaborative model of care for MATOD. The resulting model will be tested in a hybrid implementation-effectiveness trial in the Frankston-Mornington Peninsula region.
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Affiliation(s)
- Ali Cheetham
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, Australia.
| | - Kirsty Morgan
- Frankston Mornington Peninsula Primary Care Partnership, Peninsula Health, Victoria, Australia
| | - John Jackson
- Centre for Medicine Use and Safety (CMUS), Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Sarah Lord
- Pharmacotherapy Mediation, Advocacy, and Support (PAMS), Harm Reduction Victoria, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, Australia
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Tremonti C, Nielsen S. The emerging issue of Kamini: A new source of opioid dependence. Drug Alcohol Rev 2023; 42:513-514. [PMID: 36153669 DOI: 10.1111/dar.13552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Chris Tremonti
- Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology), Drug Health Services, Sydney Local Health District, Sydney, Australia
- St. Vincent's Hospital Alcohol & Drug Service, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia
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Jung M, Cangadis‐Douglass H, Nielsen S, Lalic S, Dobbin M, Russell G, Prathivadi P, Wood P, Manias E, Lee CY, Arnold C, Kuleas M, Schumann JL, Ilomäki J, Bell JS. What are the research priorities for optimising the safe and effective use of opioids in Australian general practice? Drug Alcohol Rev 2023; 42:604-613. [PMID: 36065154 PMCID: PMC10946507 DOI: 10.1111/dar.13539] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 07/02/2022] [Accepted: 08/12/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Persistent high rates of prescription opioid use and harms remain a concern in Australia, Europe and North America. Research priority setting can inform the research agenda, strategic responses and evidence-based interventions. The objective of this study was to establish research priorities related to the safe and effective use of prescription opioids in general practice. METHODS Consumers, clinicians and policy makers were invited to participate in a structured consensus workshop in May 2021. A modified nominal group technique was used to explore research priorities for the safe and effective use of opioids in Australian general practice. Research priorities were identified, consolidated and prioritised using a structured process. RESULTS Seventeen consumer, medical, pharmacy, nursing, allied health and policy participants generated 26 consolidated priorities across three domains: (i) consumer-focused priorities; (ii) clinician and practice-focused priorities; and (iii) system and policy-focused priorities. The highest ranked research priorities in each of the domains were consumer characteristics that influence opioid prescribing and outcomes, opioid deprescribing strategies, and system-level barriers to prescribing alternatives to opioids, in the consumer, clinician and practice, and system and policy domains, respectively. DISCUSSION AND CONCLUSION The priorities reflect opportunities for research priority setting within Australian general practice. The priorities provide a map for future qualitative and quantitative research that will inform safe and effective opioid prescribing.
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Affiliation(s)
- Monica Jung
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityMelbourneAustralia
| | - Helena Cangadis‐Douglass
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityMelbourneAustralia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
| | - Samanta Lalic
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityMelbourneAustralia
- Pharmacy DepartmentMonash HealthMelbourneAustralia
| | - Malcolm Dobbin
- Department of Forensic MedicineMonash UniversityMelbourneAustralia
| | - Grant Russell
- Department of General PracticeMonash UniversityMelbourneAustralia
| | | | - Pene Wood
- Department of Pharmacy and Biomedical ScienceLa Trobe UniversityBendigoAustralia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health TransformationDeakin UniversityMelbourneAustralia
- Department of Nursing, School of Health SciencesThe University of MelbourneMelbourneAustralia
- Department of MedicineRoyal Melbourne HospitalMelbourneAustralia
| | - Cik Y. Lee
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityMelbourneAustralia
- Department of Nursing, School of Health SciencesThe University of MelbourneMelbourneAustralia
| | - Carolyn Arnold
- Caulfield Pain Management and Research CentreAlfred HealthMelbourneAustralia
- Department of Anaesthesiology and Perioperative Medicine, Central Clinical SchoolMonash UniversityMelbourneAustralia
| | | | - Jennifer L. Schumann
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
- Department of Forensic MedicineMonash UniversityMelbourneAustralia
- Drug Intelligence UnitVictorian Institute of Forensic MedicineMelbourneAustralia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityMelbourneAustralia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - J. Simon Bell
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityMelbourneAustralia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
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Larney S, Jones NR, Hickman M, Nielsen S, Ali R, Degenhardt L. Does opioid agonist treatment reduce overdose mortality risk in people who are older or have physical comorbidities? Cohort study using linked administrative health data in New South Wales, Australia, 2002-17. Addiction 2023. [PMID: 36843415 DOI: 10.1111/add.16178] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 02/07/2023] [Indexed: 02/28/2023]
Abstract
AIMS To quantify the association between opioid agonist treatment (OAT) and overdose death by age group; test the hypothesis that across different age groups, opioid overdose mortality is lowest during OAT with buprenorphine compared with time out of treatment or OAT with methadone; and test associations between OAT and opioid overdose mortality in the presence of chronic circulatory, respiratory, liver and kidney diseases. DESIGN Retrospective observational cohort study using linked administrative data. SETTING New South Wales, Australia. PARTICIPANTS A total of 37 764 people prescribed OAT, 1 August 2002 and 31 December 2017. MEASUREMENTS OAT exposure, opioid overdose mortality and key confounders were measured using linked population data sets on OAT entry and exit, hospitalization, mental health care, incarceration and mortality. ICD-10 codes were used to define opioid overdose mortality and chronic disease groups of interest. FINDINGS Relative to time out of treatment, time in OAT was associated with a lower risk of opioid overdose death across all age groups and chronic diseases. Among people aged 50 years and older, there was weak evidence that buprenorphine may be associated with greater protection against opioid overdose death than methadone [generalized estimating equation (GEE) adjusted incident rate ratio (aIRR) = 0.47; 95% confidence interval (CI) = 0.21, 1.02; marginal structural models (MSM) aIRR = 0.49; 95% CI = 0.17, 1.41]. Buprenorphine was associated with greater protection against overdose death than methadone for clients with circulatory (MSM aIRR = 0.27; 95% CI = 0.11, 0.67) or respiratory (MSM aIRR = 0.26; 95% CI = 0.07, 0.94) diseases, but not liver (MSM aIRR = 0.59; 95% CI = 0.14, 2.43) or kidney (MSM aIRR = 1.16; 95% CI = 0.31, 4.36) diseases. CONCLUSIONS Opioid agonist treatment (OAT) appears to reduce mortality risk in people with opioid use disorder who are older or who have physical comorbidities. Opioid overdose mortality during OAT with buprenorphine appears to be lower and reduced in clients with circulatory and respiratory diseases compared with OAT with methadone.
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Affiliation(s)
- Sarah Larney
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Family Medicine and Emergency Medicine, University of Montreal, Montreal, Canada
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Nicola R Jones
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | | | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Clayton, Australia
| | - Robert Ali
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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Lam T, Stevens J, Nielsen S. A call to action: how can we better implement recommendations for non-routine use of modified-release opioid formulations? Anaesthesia 2023; 78:660-661. [PMID: 36756701 DOI: 10.1111/anae.15979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 02/10/2023]
Affiliation(s)
- T Lam
- Monash Addiction Research Centre, Monash University, Frankston, Australia
| | - J Stevens
- St Vincent's Clinical School, UNSW Sydney, Darlinghurst, Australia
| | - S Nielsen
- Monash Addiction Research Centre, Monash University, Frankston, Australia
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Jung M, Lukose D, Nielsen S, Bell JS, Webb GI, Ilomäki J. COVID-19 restrictions and the incidence and prevalence of prescription opioid use in Australia - a nationwide study. Br J Clin Pharmacol 2023; 89:914-920. [PMID: 36301837 PMCID: PMC9874526 DOI: 10.1111/bcp.15577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/10/2022] [Accepted: 10/20/2022] [Indexed: 01/27/2023] Open
Abstract
The COVID-19 pandemic has disrupted seeking and delivery of healthcare. Different Australian jurisdictions implemented different COVID-19 restrictions. We used Australian national pharmacy dispensing data to conduct interrupted time series analyses to examine the incidence and prevalence of opioid dispensing in different jurisdictions. Following nationwide COVID-19 restrictions, the incidence dropped by -0.40 (95% confidence interval [CI]: -0.50, -0.31), -0.33 (95% CI: -0.46, -0.21) and -0.21 (95% CI: -0.37, -0.04) per 1000 people per week and the prevalence dropped by -0.85 (95% CI: -1.39, -0.31), -0.54 (95% CI: -1.01, -0.07) and -0.62 (95% CI: -0.99, -0.25) per 1000 people per week in Victoria, New South Wales and other jurisdictions, respectively. Incidence and prevalence increased by 0.29 (95% CI: 0.13, 0.44) and 0.72 (95% CI: 0.11, 1.33) per 1000 people per week, respectively in Victoria post-lockdown; no significant changes were observed in other jurisdictions. No significant changes were observed in the initiation of long-term opioid use in any jurisdictions. More stringent restrictions coincided with more pronounced reductions in overall opioid initiation, but initiation of long-term opioid use did not change.
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Affiliation(s)
- Monica Jung
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneVictoriaAustralia,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityMelbourneVictoriaAustralia
| | - Dickson Lukose
- Monash Data Futures InstituteMonash UniversityMelbourneVictoriaAustralia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - J. Simon Bell
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneVictoriaAustralia,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityMelbourneVictoriaAustralia,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Geoffrey I. Webb
- Monash Data Futures InstituteMonash UniversityMelbourneVictoriaAustralia,Department of Data Science and Artificial IntelligenceMonash UniversityMelbourneVictoriaAustralia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical SciencesMonash UniversityMelbourneVictoriaAustralia,Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
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Lam T, Stevens J, Nielsen S. For complex problems, there are rarely simple solutions, but many pieces of an important puzzle. Anaesthesia 2023; 78:655-656. [PMID: 36718509 DOI: 10.1111/anae.15970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 02/01/2023]
Affiliation(s)
- T Lam
- Monash Addiction Research Centre, Monash University, Frankston, Australia
| | - J Stevens
- St Vincent's Clinical School, UNSW Sydney, Darlinghurst, Australia
| | - S Nielsen
- Monash Addiction Research Centre, Monash University, Frankston, Australia
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Nielsen S, Larney S. Commentary on Glanz et al.: Longer buprenorphine treatment duration is associated with lower rates of opioid overdose, but can we address barriers to staying in treatment? Addiction 2023; 118:108-109. [PMID: 36045583 PMCID: PMC10086851 DOI: 10.1111/add.16032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Melbourne, Australia
| | - Sarah Larney
- Centre de Recherche du CHUM and Department of Family Medicine and Emergency Medicine, University of Montreal, Montreal, Canada
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Francia L, Lam T, Berg A, Morgan K, Savic M, Lubman DI, Nielsen S. Putting out the welcome mat-A qualitative exploration of service delivery processes and procedures as barriers to treatment-seeking for people who use alcohol and other drugs. Drug Alcohol Rev 2023; 42:193-202. [PMID: 36169553 PMCID: PMC10947049 DOI: 10.1111/dar.13551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/26/2022] [Accepted: 08/30/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION There are a range of models and structures that determine features of alcohol and other drug treatment. Despite some structures being long-established, less is known about how specific aspects of service delivery impact treatment-seeking for people who use alcohol and other drugs. This Australian qualitative study explored both people with lived experience of problematic alcohol and other drug use, and health care staff's experiences of service delivery. METHODS Thirty-nine semi-structured interviews with people with lived experience and staff from either alcohol and other drug specialist, or broader health-care services, explored experiences of service delivery processes and procedures. Transcripts were thematically analysed and guided by a broad interest in barriers to treatment-seeking. RESULTS Within alcohol and other drug specialist services (i) time spent on wait lists; and (ii) poor implementation of assessment processes were identified barriers to treatment-seeking and engagement. Within broader health-care services (i) organisational expectations around behaviour and engagement; (ii) alcohol and other drugs viewed as separate to service role; and (iii) limited opportunities to informally engage were identified barriers to treatment-seeking. DISCUSSION AND CONCLUSIONS Results suggest opportunities to engage and undertake needs-based care planning are yet to be fully realised, particularly at the intake and assessment stages of alcohol and other drug service delivery; with frequent reassessment resulting in people repeatedly recounting traumatic experiences, often to different people, only to be placed back on wait lists with no support. Within broader health-care services aspects of service delivery may perpetuate stigma that places such people outside the purview of health care.
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Affiliation(s)
- Leanne Francia
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
| | - Tina Lam
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
| | - Amelia Berg
- Association of Participating Services UsersSelf Help Addiction Resource CentreMelbourneAustralia
| | | | - Michael Savic
- Turning PointEastern Health Clinical SchoolMelbourneAustralia
- Monash UniversityMelbourneAustralia
| | - Dan I. Lubman
- Turning PointEastern Health Clinical SchoolMelbourneAustralia
- Monash UniversityMelbourneAustralia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical SchoolMonash UniversityMelbourneAustralia
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Roxburgh A, Nielsen S. Twenty-year trends in pharmaceutical fentanyl and illicit fentanyl deaths, Australia 2001-2021. Int J Drug Policy 2022; 109:103854. [PMID: 36150355 DOI: 10.1016/j.drugpo.2022.103854] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/08/2022] [Accepted: 09/05/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Increasing overdose deaths attributable to illicitly manufactured fentanyl and fentanyl analogues in North America has driven international concern about the expansion of these substances into drug markets elsewhere. This paper investigates 20-year trends in fentanyl deaths in Australia, distinguishing between deaths attributable to pharmaceutical, and to illicitly manufactured fentanyl and fentanyl analogues. METHODS Analysis of fentanyl overdose deaths (2001-2021), extracted from the National Coronial Information System (NCIS). RESULTS 833 fentanyl-related deaths were identified, predominantly occurring among males (73%), and people with a history of injecting drug use (67%). Rates of fentanyl deaths significantly increased between 2001 and 2014 and declined between 2015 and 2021. Drug dependence remained the most significant factor in deaths among people with a history of injecting drug use (87% vs 23% without such a history), while having died by suicide was the most significant factor for those without a history of injecting drug use (20% vs 4% respectively). Three quarters (72%) of deaths were attributable to pharmaceutical fentanyl and 21% to probable pharmaceutical fentanyl, with 5% attributable to fentanyl analogues (3%) (predominantly furanylfentanyl and acetylfentanyl) and illicitly manufactured fentanyl (2%). Deaths attributable to illicitly manufactured fentanyl and fentanyl analogues occurred from 2013 onwards. CONCLUSION Pharmaceutical fentanyl deaths in Australia have declined since 2015, in parallel with overall declines in pharmaceutical opioids (including fentanyl) dispensed since 2014. Deaths continue to occur among people with a history of injecting drug use and drug dependence. Deaths attributable to illicit fentanyl have emerged since 2013 but remain low in comparison to pharmaceutical fentanyl deaths.
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Affiliation(s)
- Amanda Roxburgh
- Health Risks Program, Burnet Institute, Melbourne, Australia; Monash Addiction Research Centre, Monash University, Melbourne, Australia.
| | - Suzanne Nielsen
- Health Risks Program, Burnet Institute, Melbourne, Australia; Monash Addiction Research Centre, Monash University, Melbourne, Australia
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Picco L, Sanfilippo P, Xia T, Lam T, Nielsen S. How do patient, pharmacist and medication characteristics and prescription drug monitoring program alerts influence pharmacists' decisions to dispense opioids? A randomised controlled factorial experiment. Int J Drug Policy 2022; 109:103856. [PMID: 36150356 DOI: 10.1016/j.drugpo.2022.103856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/22/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Prescription drug monitoring programs (PDMP) are electronic databases that track the prescribing and dispensing of high-risk medicines such as opioids. They have the ability to provide clinicians with alerts, which identify medication-related risks, and are used to help inform decisions to supply. This study aimed to determine to what extent patient, pharmacist, and medication related characteristics and PDMP alerts influence decisions to dispense opioids and take other action, using a randomised controlled factorial design. METHODS Pharmacists completed an online factorial experiment, comprising six randomly generated vignettes, describing a hypothetical pharmacy patient. Pharmacists ranked the likelihood of dispensing an opioid prescription and indicated other actions, if any, they would make. Mixed-effects linear and logistical models were used to examine the association between the vignette (patient, medication and alerts), and pharmacist characteristics and the likelihood to dispense and take other actions. RESULTS 241 pharmacists were included in the analysis (n = 1353 vignettes). The PDMP alert for high dose and multiple prescriber episodes were significant predicators of reduced likelihood to dispense, with a respective 2.73- and 4.1-unit decrease in likelihood to dispense (p < 0.001). Alerts had the strongest association with other actions such as contacting the prescriber, talking to the patient and recommending naloxone, though patient and medication characteristics including age, opioid dose, benzodiazepine use and co-morbidity were also associated with increased odds of engaging in some actions. CONCLUSION PDMP alerts were the most significant predictor of reduced likelihood to dispense and were associated with the greatest odds of taking other actions. Well-established risk factors such as high dose and high-risk drug combinations, in the absence of PDMP alerts, were associated with some actions, though to a lesser degree than PDMP alerts. These findings have significant policy implications and suggest PDMP alerts are a greater driver of decisions to dispense opioids and take other actions, compared with other known clinical risk factors.
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Affiliation(s)
- Louisa Picco
- Monash Addiction Research Centre, Eastern Health, Clinical School, Monash University, 47-49 Moorooduc Hwy Frankston, Melbourne, Victoria 3199, Australia.
| | - Paul Sanfilippo
- Monash Addiction Research Centre, Eastern Health, Clinical School, Monash University, 47-49 Moorooduc Hwy Frankston, Melbourne, Victoria 3199, Australia
| | - Ting Xia
- Monash Addiction Research Centre, Eastern Health, Clinical School, Monash University, 47-49 Moorooduc Hwy Frankston, Melbourne, Victoria 3199, Australia
| | - Tina Lam
- Monash Addiction Research Centre, Eastern Health, Clinical School, Monash University, 47-49 Moorooduc Hwy Frankston, Melbourne, Victoria 3199, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health, Clinical School, Monash University, 47-49 Moorooduc Hwy Frankston, Melbourne, Victoria 3199, Australia
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Abstract
BACKGROUND There are ongoing concerns regarding pharmaceutical opioid-related harms, including overdose and dependence, with an associated increase in treatment demand. People dependent on pharmaceutical opioids appear to differ in important ways from people who use heroin, yet most opioid agonist treatment research has been conducted in people who use heroin. OBJECTIVES: To assess the effects of maintenance opioid agonist pharmacotherapy for the treatment of pharmaceutical opioid dependence. SEARCH METHODS We updated our searches of the following databases to January 2022: the Cochrane Drugs and Alcohol Group Specialised Register, CENTRAL, MEDLINE, four other databases, and two trial registers. We checked the reference lists of included studies for further references to relevant randomised controlled trials (RCTs). SELECTION CRITERIA We included RCTs with adults and adolescents examining maintenance opioid agonist treatments that made the following two comparisons. 1. Full opioid agonists (methadone, morphine, oxycodone, levo-alpha-acetylmethadol (LAAM), or codeine) versus different full opioid agonists or partial opioid agonists (buprenorphine) for maintenance treatment. 2. Full or partial opioid agonist maintenance versus non-opioid agonist treatments (detoxification, opioid antagonist, or psychological treatment without opioid agonist treatment). DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. MAIN RESULTS We identified eight RCTs that met inclusion criteria (709 participants). We found four studies that compared methadone and buprenorphine maintenance treatment, and four studies that compared buprenorphine maintenance to either buprenorphine taper (in addition to psychological treatment) or a non-opioid maintenance treatment comparison. We found low-certainty evidence from three studies of a difference between methadone and buprenorphine in favour of methadone on self-reported opioid use at end of treatment (risk ratio (RR) 0.49, 95% confidence interval (CI) 0.28 to 0.86; 165 participants), and low-certainty evidence from four studies finding a difference in favour of methadone for retention in treatment (RR 1.21, 95% CI 1.02 to 1.43; 379 participants). We found low-certainty evidence from three studies showing no difference between methadone and buprenorphine on substance use measured with urine drug screens at end of treatment (RR 0.81, 95% CI 0.57 to 1.17; 206 participants), and moderate-certainty evidence from one study of no difference in days of self-reported opioid use (mean difference 1.41 days, 95% CI 3.37 lower to 0.55 days higher; 129 participants). There was low-certainty evidence from three studies of no difference between methadone and buprenorphine on adverse events (RR 1.13, 95% CI 0.66 to 1.93; 206 participants). We found low-certainty evidence from four studies favouring maintenance buprenorphine treatment over non-opioid treatments in terms of fewer opioid positive urine drug tests at end of treatment (RR 0.66, 95% CI 0.52 to 0.84; 270 participants), and very low-certainty evidence from four studies finding no difference on self-reported opioid use in the past 30 days at end of treatment (RR 0.63, 95% CI 0.39 to 1.01; 276 participants). There was low-certainty evidence from three studies of no difference in the number of days of unsanctioned opioid use (standardised mean difference (SMD) -0.19, 95% CI -0.47 to 0.09; 205 participants). There was moderate-certainty evidence from four studies favouring buprenorphine maintenance over non-opioid treatments on retention in treatment (RR 3.02, 95% CI 1.73 to 5.27; 333 participants). There was moderate-certainty evidence from three studies of no difference in adverse effects between buprenorphine maintenance and non-opioid treatments (RR 0.50, 95% CI 0.07 to 3.48; 252 participants). The main weaknesses in the quality of the data was the use of open-label study designs, and difference in follow-up rates between treatment arms. AUTHORS' CONCLUSIONS There is very low- to moderate-certainty evidence supporting the use of maintenance agonist pharmacotherapy for pharmaceutical opioid dependence. Methadone or buprenorphine did not differ on some outcomes, although on the outcomes of retention and self-reported substance use some results favoured methadone. Maintenance treatment with buprenorphine appears more effective than non-opioid treatments. Due to the overall very low- to moderate-certainty evidence and small sample sizes, there is the possibility that the further research may change these findings.
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Affiliation(s)
- Suzanne Nielsen
- Monash Addiction Research Centre, Monash University, Frankston, Australia
| | - Wai Chung Tse
- Monash Addiction Research Centre, Monash University, Frankston, Australia
- School of Medicine, Monash University, Melbourne, Australia
| | - Briony Larance
- School of Psychology, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, Australia
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