What are the research priorities for optimising the safe and effective use of opioids in Australian general practice?

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.

Real-time prescription monitoring: helping people at risk of harm.

Misuse of opioid analgesics and other psychoactive medicines is a serious and increasing problem in Australia. Measures are being taken to try and prevent this progressing to a public health crisis like the opioid overdose epidemic seen in the USA One measure is real-time prescription monitoring. This provides real-time information about the patient’s supply of psychoactive medicines which have a high risk of being misused Having identified a patient at risk, many factors may delay appropriate management or result in the patient being discharged from care.

Chronic pain medication management of older populations: Key points from a national conference and innovative opportunities for pharmacy practice.

Objective: Inappropriate use of pain medication has serious consequences for older populations. Experts in the field have noted an increase in opioid prescriptions, and opioid-related hospitalisations and deaths among this vulnerable population. In the pursuit of educating pharmacists, physicians, allied healthcare professionals, researchers, academics and the public facing the challenges of chronic pain medication management, 'The Inaugural Monash University School of Public Health and Preventive Medicine (SPHPM) Best Practice in Chronic Pain Medication Management Day Conference' was held in December 2016 at the Alfred Medical Research and Education Precinct (Melbourne, Australia).

Unintentional mortality associated with paracetamol and codeine preparations, with and without doxylamine, in Australia.

Introduction: Misuse of paracetamol, codeine and doxylamine combination analgesics may lead to addiction and mortality. This study aimed to (1) identify unintentional deaths in Australia associated with use of combination analgesic products containing paracetamol, codeine and doxylamine; (2) describe cases characteristics, including demographics and additional medication use; and (3) identify common factors associated with misuse and mortality of these medicines in Australia.

Design: This retrospective case series analysed National Coronial Information System data to identify cases of unintentional death attributable to paracetamol, codeine and doxylamine products between 2002 and 2012.

Regulatory responses to over-the-counter codeine analgesic misuse in Australia, New Zealand and the United Kingdom.

Objective: Analysis of the policy response by Australia's National Drugs and Poisons Schedule Committee (NDPSC) and comparison with recommendations by expert advisory committees in New Zealand and the United Kingdom.

Methods: Analysis of public policy documents of relevant regulatory authorities was conducted. Data were extracted regarding changes to over-the-counter (OTC) codeine analgesic scheduling, indications, maximum unit dose, maximum daily dose, maximum pack size, warning labels, consumer medicine information and advertising.

Beyond the paper trail: using technology to reduce escalating harms from opioid prescribing in Australia.

Objective: The paper highlights the extent of pharmaceutical drug misuse problems in Australia and explores how pharmaceutical opioid misuse could be reduced by implementation of a technological tool: a prescription co-ordination program (PCP). The paper explores how enhancements to existing computer-assisted clinical decision support systems through real-time, on-line information to prescribers, pharmacists and regulators could address drug-seeking and improve the quality use of medicines.

Approach: Trends in national and international prescription opioid use and related harms are examined with attention directed to drug-seeking behaviour and intentional misuse.

Recent increase in detection of alprazolam in Victorian heroin-related deaths.

Objectives: To examine the rate of detection of alprazolam among cases of heroin-related death (HRD) in Victoria, including the relationship between alprazolam supply and HRDs.

Design And Setting: Population-based study of community alprazolam supply in Victoria and HRDs reported to the Victorian coroner from January 1990 to December 2010.

Main Outcome Measures: Number of prescriptions for alprazolam supplied; defined daily dose (DDD) per 1000 population per 04 of alprazolam; number of cases of HRD in which alprazolam was detected through postmortem toxicological testing.

Over-the-counter codeine analgesic misuse and harm: characteristics of cases in Australia and New Zealand.

Aim: To describe the characteristics of clients addicted to over-the-counter (OTC) codeine analgesics presenting to an Auckland open-access clinic, and to compare them to clients admitted to a New Zealand detoxification unit, and in the Australian community.

Method: Cross-sectional study of clients presenting to a regional, open-access detoxification clinic covering the Greater Auckland area between 1 January and 31 March 2010.

Results: Fifteen clients were analysed, and compared to 77 similar clients identified in Victoria and five other Australian States, and 7 clients admitted to a New Zealand detoxification unit.

Increasing the benefits and reducing the harms of prescription opioid analgesics.

Issues: Consumption of prescription opioid analgesics (POAs) in Australia has increased steadily in recent years, raising concerns of increasing harms including overdose and dependence, as has occurred in the USA.

Approach: Exposition of the Royal Australasian College of Physicians Prescription Opioid Policy with reference to the published literature, drawing out principles for harm reduction for psychoactive pharmaceutical drugs.

Key Findings: Complex professional, patient, regulatory and market factors influence health professionals balancing the benefits and harms of POAs.

Increasing deaths involving oxycodone, Victoria, Australia, 2000-09.

Objective: In light of an emerging epidemic identified in the United States and Canada, to identify trends in fatal drug toxicity involving oxycodone and the demographic characteristics and indicators of socioeconomic disadvantage of the deceased.

Study Design: Population-based observational study in Victoria, Australia.

Population: Decedents whose death was reported to the Victorian Coroner between 2000 and 2009 and where oxycodone was detected.

Serious morbidity associated with misuse of over-the-counter codeine-ibuprofen analgesics: a series of 27 cases.

Objective: To investigate morbidity related to misuse of over-the-counter (OTC) codeine-ibuprofen analgesics.

Design And Setting: Prospective case series collected from Victorian hospital-based addiction medicine specialists between May 2005 and December 2008.

Main Outcome Measures: Morbidity associated with codeine-ibuprofen misuse.

Improving the management of chronic non-malignant pain and reducing problems associated with prescription opioids.

New guidelines and a multidisciplinary approach have the potential to help patients in need while minimising inappropriate use of opioids.

Buprenorphine diversion and injection in Melbourne, Australia: an emerging issue?

Aims: To examine indicators of buprenorphine diversion and injection among injecting drug users in Melbourne, Australia and to determine the factors associated with buprenorphine injection.

Design: Melbourne arm of the 2002 Illicit Drug Reporting System (IDRS) cross-sectional study.

Setting: Five Needle and Syringe Programme sites in Melbourne, Australia.

Association of benzodiazepine injection with the prescription of temazepam capsules.

Temazepam capsules have become a popular choice for benzodiazepine injection by injecting drug users, and serious vascular and tissue damage leading to ulcers and gangrene can result. We compared the self-reported benzodiazepine injecting behaviour of 91 heroin users with their Pharmaceutical Benefits Schedule (PBS) records for the preceding 5 years. We found that individuals prescribed PBS temazepam capsules were more likely to report injecting benzodiazepines than individuals who had either not been prescribed PBS temazepam capsules or had been prescribed PBS temazepam tablets.