POINT Study (Pain and Opioids IN Treatment)

Date Commenced:
01/2012
Expected Date of Completion:
12/2019
Project Supporters:

National Health and Medical Research Council

Drug Type:
Pain and opioids in treatment (POINT) project
Project Members
image - 1314151114 Marian Shanahan 011
Senior Research Fellow
Ph 02 9385 0333
image - Briony Larance Square
Senior Lecturer
Ph 02 9385 0333
image - Suzanne Nielsen Square
Senior Lecturer
Ph 02 8936 1017
image - Teleri Moore Square
Research Assistant
Ph (02) 9385 0333
image - 1314143637 Campbell Gabrielle 08
Senior Research Officer
Ph 02 9385 0286
image - Timothy Dobbins Square
Associate Professor
Ph +61 (2) 9385 0333
Professor Wayne Hall
Conjoint Professor
image - Michael Farrell  Square
Director
Ph EA Jemma Sale: 02 9385 0292 / j.sale@unsw.edu.au
Dr Raimondo Bruno
Conjoint Associate Professor
Project Collaborators: External

A/Prof Fiona Byth (Sydney University)

A/Prof. Milton Cohen (St. Vincent’s Hospital, Pain Clinic)

A/Prof. Nick Lintzeris (University of Sydney/SESIAHS)

Project Main Description

There has been a recent increase in the prescribing of pharmaceutical opioids to Chronic Non-Cancer Pain (CNCP) patients in Australia which has led to increasing professional and public concern about the use and harms that may be related to such use. Despite this, there is very little known about the magnitude of risk for adverse events. Previous Australian research has had limited duration (~ 12 weeks) and/or have not examined aberrant drug use behaviours. This current study is to be the first Australian study to examine the patterns of prescribing for individual patients, and the outcomes for these patients in the longer term. With the recent start of POINT II, this current study will follow participants for up to 5 years. 

Aims
  1. To examine the rates, patterns and duration of opioid analgesic prescribing at across Australia
  2. To estimate the population-level risk of adverse events among those prescribed opioids, including incidence of hospital stays, transfer to opioid substitution treatment, and mortality
  3. To examine the natural history of opioid analgesic use in a cohort of patients prescribed opioids for chronic non-cancer pain (CNCP)
  4. To examine the demographic and clinical predictors of adverse events among a cohort of CNCP patients, including opioid abuse or dependence, medication diversion, other drug use, and overdose
  5. To identify factors which predict poor self-reported pain relief and other indicators of clinical outcomes.
Design and Method

The POINT study is a national prospective cohort that aims to follow 1500 chronic pain patients newly prescribed pharmaceutical opioids over a 24 month period. Follow-ups have occurred at three months, 12 months and 24 months. POINT II follow ups will occur at 3, 4 and 5 years. The interviews will cover topics such as; demographics, chronic pain, treatment, physical and mental health, physical functioning, social support and current and lifetime substance use. Participants will be recruited through pharmacies throughout Australia. We will continue to follow patients that discontinue their pharmaceutical opioid in order to examine reasons and effects of discontinuance. 

Progress/Update

POINT I

The POINT study was approved by the university ethics committee in May, 2012 and National Pharmacy Guild in July, 2012. Recruitment for the study began late August 2012. Baseline interviews of 1,514 participants were completed in April 2014 and 3-month self-complete surveys completed in September 2014, with a follow-up rate of 80%. 12-month surveys were completed in June 2015, with a follow-up rate of 82%. In December 2015 2- year interviews were finished, with a follow up rate of 85%.

POINT II

Funding for POINT II was received from the NHMRC in December 2015, allowing another 3 years of follow up interviews to track the POINT cohort. POINT II started January 2016, with participants completing a 30-45 minute interview over the phone.  To date 30 interviews have been completed.

Through collating data over 5 years, POINT II aims to answer the following questions;

  1. What is the impact of opioids for CNCP on pain, functioning, quality of life, healthcare, and healthcare costs over 5 years?
  2. What predicts transitions to and from opioid non- adherence and dependence over 5 years?
  3. What are CNCP patients preferences with respect to outcomes, side-effects, different medications and to non-medication approaches to pain management?
Output

Peer-reviewed papers

Accepted or published

1.      Degenhardt, L. Gilmour, S., Shand, F., Bruno, R., Campbell, G., Mattick, R.P., Larance, B., & Hall, W. (2013). Estimating the proportion of prescription opioids that is consumed by people who inject drugs in Australia.  Drug and Alcohol Review, 32(5), 468-475.

2.      Shand, F., Campbell, G., Hall, W., Lintzeris, N., Cohen, M., Degenhardt, L. (2013). Real time monitoring of Schedule 8 medicines in Australia: evaluation is essential. Medical Journal of Australia, 198(2), 80-81.

3.      Belcher, J., Nielsen, S., Campbell, G., Bruno, R., Larance, B., Lintzeris, N., & Degenhardt, L., (2014). Diversion of prescribed opioids by people living with chronic pain: Results from an Australian community sample. Drug and Alcohol Review, 33(1), 27-32.

4.      Campbell, G., Mattick, R., Bruno, R., Larance, B., Nielsen, S., Cohen, M., Lintzeris, N., Shand, F., Hall, W., Hoban, B., Kehler, C., Farrell, M., & Degenhardt, L. (2014). Cohort protocol: The Pain and Opioids IN Treatment (POINT) study. BMC Pharmacology and Toxicology, 15; 17

5.      Nielsen, S., Lintzeris, N., Bruno, R., Campbell, G., Larance, B., Hoban, B., Hall, W., Cohen, M., & Degenhardt, L. (2015). Benzodiazepine use amongst chronic pain patients prescribed opioids: associations with pain, physical and mental health and health service utilization. Pain Medicine 16(2), 356-366.

6.      Campbell, G., Nielsen, S., Bruno, R., Lintzeris, N., Cohen, M., Hall, W., Larance, B., Mattick, R.P., & Degenhardt, L. (2015). The Pain and Opioids IN Treatment (POINT) study: Characteristics of a cohort using opioids to manage chronic non-cancer pain. Pain 156(2), 231-242.

7.      Degenhardt, L., Lintzeris, N., Campbell, G., Bruno, R., Cohen, M., Farrell, M., & Hall, W., (2015). Experience of adjunctive cannabis use for chronic non-cancer pain: Findings from the Pain and Opioids IN Treatment (POINT) study. Drug and Alcohol Dependence, 147, 144-150.

8.      Degenhardt, L., Bruno, R., Lintzeris, N., Hall, W., Nielsen, S., Larance, B., Cohen, M., & Campbell, G., (2015). DSM and ICD definitions of pharmaceutical opioid use disorders and dependence in people treated with opioids for chronic pain: Findings from the Pain and Opioids IN Treatment (POINT) study. The Lancet Psychiatry, 2(4), 314-322.

9.      Campbell, G., Nielsen, S., Bruno, R., Larance, B., Smith, K., Hall, W., Cohen, M., & Lintzeris, N., & Degenhardt, L., (in press). Pharmaceutical Opioid Use and Dependence among People Living with Chronic Pain: Associations Observed within the Pain and Opioids in Treatment (POINT) Cohort. Pain Medicine 16(9), 1745-1758.

10.  Lintzeris, N., Campbell, G., Moodley, R., Bruno, R., Larance, B., Nielsen, S., & Degenhardt, L. (Accepted July 2015). Sleep quality among people living with chronic non-cancer pain: Findings from the Pain and Opioids IN Treatment (POINT) cohort. Clinical Journal of Pain

11.  Smith, K., Mattick, R., Bruno, R., Nielsen, S., Cohen, M., Campbell, G., Larance, B., Farrell, M. & Degenhardt, L. (2015). Factors associated with the development of depression in chronic non-Cancer pain patients following the onset of opioid treatment for pain. Journal of Affective Disorders 184, 72-80

12.  Campbell, G., Bruno, R., Darke, S., & Degenhardt, L(2015). Associations of borderline personality with pain, problems with medications and suicidality in a community sample of chronic non-cancer pain patients prescribed opioids for pain. General Hospital Psychiatry 37(5), 434-440.

13.  Hoban, B., Larance, B., Gisev, N., Nielsen, S., Cohen, M., Bruno, R., Shand, F., Lintzeris, N., Hall, W., Farrell, M., & Degenhardt, L. (2015). The use of paracetamol above recommended maximum daily doses by people with chronic non-cancer pain. International Journal of Clinical Practice 69(11), 1366-1376

14.  Campbell, G., Bruno, R., Shand, F., Hall, W., Darke, S., Farrell, M., & Degenhardt, L. (accepted July, 2015). Prevalence and correlates of suicidal thoughts and suicide attempts in people prescribed pharmaceutical opioids for chronic pain. Clinical Journal of Pain.

15.  Peacock, A., Degenhardt, L., Campbell, G., Larance, B., Nielsen, S., Hall, W., Mattick, R.P. M. & Bruno, R. (accepted September 2015). A typology of predictive risk factors for non-adherent medication-related behaviors among chronic non-cancer pain patients prescribed opioids: A cohort study. Pain Medicine

16.  Nielsen, S., Campbell, G., Peacock, A., Smith, K., Bruno, R., Hall, W., Cohen, M. & Degenhardt, L. (Accepted November 2015). Health service utilisation by people living with chronic non-cancer pain: findings from the Pain and Opioids IN Treatment (POINT) study. Australian Health Review.

17.  Nielsen, S., Degenhardt, L. Hoban, B. & Gisev, N. (accepted December, 2015). A synthesis of oral morphine equivalents (OME) for opioid utilisation studies. Pharmacoepidemiology and Drug Safety

Under review

18.  Larance, B., Campbell, G., Peacock, A., Lintzeris, N., Bruno, R., Farrell, M., & Degenhardt, L. (submitted). Alcohol use disorders, risky drinking and adverse events among chronic non-cancer pain patients receiving opioid therapy. Drug and Alcohol Dependence

19.  Peacock, A., Nielsen, S., Bruno, R., Campbell, G., Larance, B. & Degenhardt, L. (submitted) Geographic variation in use and perceived barriers to access of health services for people with chronic non-cancer pain in Australia. Pain Medicine.

20.  Campbell, G., Bruno, R., Lintzeris, N., Cohen, M., Nielsen, S., Hall, W., Larance, B., Mattick, R.P., Blyth, F., Farrell, M. & Degenhardt, L. (submitted). Defining problematic pharmaceutical opioid use among people prescribed opioids for chronic non-cancer pain: do different measures identify the same patients? Pain

Presentations

Invited presentations based on POINT data

1.         Campbell, G. and Hoban, B (2013). POINT: Pain and Opioids IN Treatment study: Preliminary findings. Invited to present at the National Pharmacy Guild Conference, Sydney Convention Centre, June 22nd 2013.

2.         Degenhardt, L., (2013). Morbidity and mortality among people using opioid medications. Invited symposium presentation at the International Society for Addiction Medicine (ISAM) meeting, Kuala Lumpur, Malaysia, November 21-23rd 2013.

3.         Degenhardt, L. (2014). Non-adherence, diversion and opioid use disorders among people living with chronic pain. Invited panel at the AIM of Pain conference Sydney, February 14th 2014.

4.         Degenhardt, L. (2014). The use, misuse, diversion and harms related to pharmaceutical opioids in Australia: What do we know? Invited presentation at the Australian Pain Society conference, Hobart, April 14th 2014.

5.         Campbell, G. (2014). POINT: Pain and Opioids IN Treatment study: Preliminary findings. Invited presentation at the National Pharmacy Guild Conference, Sydney Convention Centre, 21st June, 2014.

6.         Degenhardt, L. (2014). The use, misuse, diversion and harms related to pharmaceutical opioids in Australia: What do we know? Invited presentation at the Drug and Alcohol Nurses’ Association (DANA) conference, Sydney, September 5th 2014.

7.         Degenhardt, L. Campbell, G., Larance, B., Nielsen, S., Hall, W., Cohen, M., Lintzeris, N., Bruno, R., Mattick, R.P, Hoban, B., Smith, K., Moodley, R., Urquhart-Secord, R., Shand F. & Farrell, M. (2014). The complexities of chronic pain: findings from a cohort of 1,500 Australians taking prescription opioids for non-cancer pain. Keynote presented at the NDARC annual symposium, Sydney, September 8th 2014.

8.         Degenhardt, L. (2014). The complexities and consequences of pharmaceutical opioids. Invited Plenary presented at the 34th Australian Professional Society on Alcohol and Drugs (APSAD) Conference, Adelaide, November 12th 2014.

9.                   Degenhardt, L.(2015). Pharmaceutical opioids in Australia: Complexities, comorbidities and consequences? Invited presentation at the Australian Pain Society conference, Brisbane, March 16th 2015.

10.               Larance, B. (2015). Pharmaceutical opioid use in Australia. Invited plenary presented at the Pharmacy Guild Conference, Brisbane, March 14th 2015.

11.               Campbell, G. (2015).Pharmaceutical opioid use and dependence among people living with chronic pain: Associations observed within the Pain and Opioids IN Treatment (POINT) cohort. St. Vincent’s weekly seminar, Drug and Alcohol Services, 7th July, 2015

Other presentations based on POINT data

1.       Campbell, G. (2013). Trends in pharmaceutical prescribing, diversion, misuse and harms, Australia, Presentation at NSW Pharmacy Guild Workshop, Sydney, NSW, Australia, 13 May 2013.

2.       Campbell G, Hoban B, Larance B, Bruno R, Nielsen S, Shand F, Hall W, Cohen M, Lintzeris N, Farrell M, Mattick R, Degenhardt L.  Preliminary results of the Pain and Opioids In Treatment (POINT) study. NSW Pharmacy Guild Conference, June 2013.

3.       Campbell, G., Hoban, B. and Martin, A. (2013) POINT: Pain and Opioids IN Treatment study: Preliminary findings. Presentation at the NDARC in-house seminar series, Sydney, NSW Australia, May 2013.

4.       Campbell, G. Trends in pharmaceutical prescribing, diversion, misuse and harms, Australia. NSW Pharmacy Guild - Drugs on the Street Workshop, Sydney, Australia, May 2013.

5.       Campbell, G. and Hoban, B. (2014) POINT: Pain and Opioids IN Treatment study: Preliminary findings. Presentation at the NDARC in-house seminar series, Sydney, NSW Australia, 26th June 2014.

6.       Campbell, G. Degenhardt, D., Larance, B., Nielsen, S., Hall, W., Cohen, M., Lintzeris, N., Bruno, R., Mattick, R., Shand, F. and Farrell, M. (2014). Characteristics of a national sample of people with chronic non-cancer pain prescribed opioids. Symposium presentation at the Australian Professional Society on Alcohol and other Drugs, Adelaide Convention Centre, 10th November, 2014.

7.       Larance, B., Peacock, A., Campbell, G., Freckleton, S., Smith, K., Mattick, R., Bruno, R., Nielsen, S., Cohen, M., Lintzeris, N., Shand, F., Hall, W., Farrell, M., Degenhardt, L. (2014) Alcohol use disorders, risky alcohol consumption and adverse events among chronic non-cancer pain patients receiving opioid therapy.  Presentation to the Australian Professional Society on Alcohol and other Drugs, Adelaide Convention Centre, 10-12th November, 2014.

8.       Hoban B, Larance B, Gisev N, Nielsen S, Cohen M, Bruno R, Shand F, Lintzeris N, Hall W, Farrell M, Degenhardt L. The use of paracetamol above recommended maximum daily doses among people with chronic non-cancer pain. Postgraduate Research Symposium, UNSW, Sydney, August 2014.

9.       Hoban B, Larance B, Gisev N, Nielsen S, Bruno R, Degenhardt L. Sedative load among people with chronic non-cancer pain prescribed opioids:  associations with drowsiness and emergency health service utilization. National Drug and Alcohol Research Centre Seminar Series, March 2015.

10.   Hoban B, Larance B, Gisev N, Nielsen S, Bruno R, Degenhardt L. Sedative load among people with chronic non-cancer pain prescribed opioids: associations with drowsiness and emergency health service utilization. Australian Pain Society Conference, March 2015.

11.   L. Degenhardt, R. Bruno, N. Lintzeris, W. Hall, S. Nielsen, B., Larance, M. Cohen, G. Campbell Examining DSM and ICD definitions of pharmaceutical opioid dependence in people taking opioids for chronic pain: Findings from the Pain and Opioids IN Treatment (POINT) study. College on Problems of Drug Dependence 77th Annual Scientific Meeting; Phoenix, Arizona, June 2015.

12.   G. Campbell, S. Nielsen, B. Larance, R. Bruno, R. Mattick, W. Hall, N. Lintzeris, M. Cohen, K. Smith, L. Degenhardt.Pharmaceutical opioid use and dependence among people living with chronic pain: Associations observed within the Pain and Opioids IN Treatment (POINT) cohort. College on Problems of Drug Dependence 77th Annual Scientific Meeting; Phoenix, Arizona, June 2015.

13.   Campbell, G., Darke, R., Bruno, R. & Degenhardt, L. Prevalence, correlates and associations of suicidality in people with chronic non-cancer pain. Oral presentation The National Suicide Prevention conference 26-29th July, Hobart, Tasmania

14.   G. Campbell, S. Nielsen, B. Larance, R. Bruno, R. Mattick, W. Hall, N. Lintzeris, M. Cohen, K. Smith, L. Degenhardt. Pharmaceutical opioid use and dependence among people living with chronic pain: Associations observed within the Pain and Opioids IN Treatment (POINT) cohort. NDARC Annual Symposium, September 2015

Poster presentations

1.       Hoban, B., Larance, B., Gisev, N., Nielsen, S., Cohen, M., Bruno, R., Shand, F., Lintzeris, N., Hall, W., Farrell, M., & Degenhardt, L.(2013). The therapeutic and above therapeutic use of paracetamol among chronic non-cancer pain patients.Poster presented at the National Drug and Alcohol Research Centre Annual Symposium, September, 2013, University of New South Wales.

2.       Nielsen S, Bruno R, Campbell G, Cohen M, Farrell M, Hall W, Hoban B, Larance B, Lintzeris N, Mattick, R & Degenhardt L. (2014) Benzodiazepine use amongst a sample of chronic pain patients prescribed opioids.  College on Problems of Drug Dependence 76th Annual Meeting; San Juan, Puerto Rico.

3.       Campbell, G. (2014). Characteristics of a national sample of people with chronic non-cancer pain prescribed prescription opioids. Poster presented at the National Drug and Alcohol Research Centre Annual Symposium, September, 2014, University of New South Wales.

4.       Hoban, B., Nielsen, S., Gisev, N., Larance, B., Bruno, R., Lintzeris, N., Degenhardt, L.(2014). Associations with a sedative load index in people with chronic non-cancer pain prescribed opioids: Quantifying polypharmacy in the Pain and Opioids In Treatment (POINT) study.Poster presented at the National Drug and Alcohol Research Centre Annual Symposium, September, 2014, University of New South Wales.

5.       Larance, B., Peacock, A., Campbell, G., Freckleton, S., Smith, K., Mattick, R., Bruno, R., Nielsen, S., Cohen, M., Lintzeris, N., Shand, F., Hall, W., Farrell, M., Degenhardt, L. (2014) Alcohol use disorders, risky alcohol consumption and adverse events among chronic non-cancer pain patients receiving opioid therapy.  Poster at the National Drug and Alcohol Research Centre (NDARC) Symposium, September 2014, University of New South Wales, Sydney.

6.       Moodley, R., Lintzeris, N., Campbell, G., Bruno, R., Larance, B., Nielsen, S., & Degenhardt, L. (2014). Sleep quality among people living with chronic non-cancer pain: Findings from the Pain and Opioids IN Treatment (POINT) cohort. Poster presented at the National Drug and Alcohol Research Centre Annual Symposium, September, 2014, University of New South Wales.

7.       Smith K, Mattick R.P, Campbell G, Larance B & Degenhardt L. (2014) Correlates of depressive disorders with an onset post-opioid initiation among chronic non-cancer pain patients. Presented at the National Drug and Alcohol Research Centre Annual Symposium, September 2014, University of New South Wales.

8.       Peacock, A., Degenhardt, L., Lintzeris, N., Larance, B., Campbell, G., Nielsen, S., Cohen, M., & Bruno, R. (2015). Opioid therapy for chronic non-cancer pain: Does typology of risk predict aberrant behaviour? College on Problems of Drug Dependence 77th Annual Scientific Meeting; Phoenix, Arizona.

9.       Larance, B., Peacock, A., Campbell, G. Bruno, R., Mattick, R., Nielsen, S., Cohen, M., Smith, K., Degenhardt, L. (2015) Alcohol use disorders and risky alcohol consumption among chronic non-cancer pain patients receiving opioid therapy.  College on Problems of Drug Dependence 77th Annual Scientific Meeting; Phoenix, Arizona, June 2015.

10.   G. Campbell, S. Nielsen, B. Larance, R. Bruno, R. Mattick, W. Hall, N. Lintzeris, M. Cohen, K. Smith, L. Degenhardt. Pharmaceutical opioid use and dependence among people living with chronic pain: Associations observed within the Pain and Opioids IN Treatment (POINT) cohort. National Institute on Drug Abuse (NIDA) International Forum; Phoenix, Arizona.

11.   Degenhardt, L., Lintzeris, N., Campbell, G., Bruno, R., Cohen, M., Farrell, M., & Hall, W., (2015). Experience of adjunctive cannabis use for chronic non-cancer pain: Findings from the Pain and Opioids IN Treatment (POINT) study. National Institute on Drug Abuse (NIDA) International Forum; Phoenix, Arizona.

12.   Hoban B, Larance B, Gisev N, Nielsen S, Bruno R, Degenhardt L. Sedative load among people with chronic non-cancer pain prescribed opioids: associations with drowsiness and emergency health service utilization. European 9th congress of the European pain federation (EFIC) September 2015.

13.   S. Nielsen, G. Campbell, B. Larance, R. Bruno, R. Mattick, W. Hall, N. Lintzeris, M. Cohen, K. Smith, L. Degenhardt. Is higher opioid dose associated with better functioning or more pain relief? Findings from the pain and opioids in treatment (point) study.European 9th congress of the European pain federation (EFIC) September 2015.

14.   Campbell, G., Darke, R., Bruno, R. & Degenhardt, L. Prevalence, correlates and associations of suicidality in people with chronic non-cancer pain. Poster presentation NDARC Annual Symposium, September, 2015

15.   Hoban B, Larance B, Gisev N, Nielsen S, Bruno R, Degenhardt L. Sedative load among people with chronic non-cancer pain prescribed opioids: associations with drowsiness and emergency health service utilization. Poster presentation NDARC Annual Symposium, September, 2015

Benefits

The POINT project was the first large-scale Australian prospective cohort study to rigorously examine opioid analgesic prescribing patterns amongst chronic pain patients at a population level, and their relationship to important health outcomes and mortality. It was the first to comprehensively examine the extent, to which opioid therapy for chronic pain is associated with pain reduction, adverse events including side effects, quality of life, and mental and physical health outcomes.

Currently, the evidence base for the regulation and monitoring of opioid analgesics is weak. Regulators across jurisdictions use different criteria for authorising long-term opioid therapy, and different criteria for identifying at-risk patients. The results of this study will assist doctors and regulators in Australia to better identify those patients who are at risk of adverse outcomes and who therefore require alternative treatment strategies. Improved understanding of the longer-term outcomes of chronic opioid therapy will direct community-based interventions and health policy in Australia

Through another 3 years of follow up interviews, POINT II will further be able to shed light on the extent to which patients experience problematic opioid use, some of the precursors and protective factors to problematic use, and the consequences of problematic opioid use resulting from chronic opioid therapy. It will lead to improved knowledge of dose escalation and the positive and negative outcomes for those who undergo rapid dose escalation and ultimately end up using high doses of opioid analgesics.

POINT II also aims to establish a long term trajectory of potential impacts on health care use and costs. It will investigate patient preferences for interventions that improve pain and functioning, providing insight into why some ineffective but expensive treatments are used and why long term opioid use persists even in light of little clinical benefit.

Finally, the project will achieve the establishment of a cohort of Australians with chronic health problems. The project will provide the groundwork for further follow-up of the sample to determine the longer-term outcomes for chronic pain patients.

Project Supporters

National Health and Medical Research Council

Drug Type
Project Status
Current
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