POINT Study (Pain and Opioids IN Treatment)

Tags: opioids
Date Commenced:
01/2012
Expected Date of Completion:
12/2016
Project Supporters:

National Health and Medical Research Council

Drug Type:
Pain and opioids in treatment (POINT) project
Project Members
image - Michael Farrell  Square
Professor and Director
Ph EA Jemma Sale: 02 9385 0292 / j.sale@unsw.edu.au
image - Briony Larance Square
Research Fellow
Ph 02 9385 0333
image - Suzanne Nielsen Square
Senior Lecturer
Ph 02 8936 1017
image - 1314143637 Campbell Gabrielle 08
Senior Research Officer
Ph 02 9385 0286
image - 1354251698 Bianca Hoban Square
Research Assistant
Ph 02 9385 0333
image - Sarah Freckleton Square 2
Ms Sarah Freckleton
Research Assistant
image - Ndarc 018
Research Assistant
Ph 02 9385 0333
image - Rachel Urqhart Square
Ms Rachel Urquhart-Secord
Research Assistant
Project Collaborators: External

Dr Fiona Shand (Black Dog Institute, University of New South Wales)

Professor Wayne Hall (University of Queensland)

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

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

Dr Raimondo Bruno (University of Tasmania)

Project Main Description

There has been a recent increase in the prescribing of pharmaceutical opioids in Australia which has lead 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.

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 will occur at three months, 12 months and 24 months. 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

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%. 1,254 12-month surveys have been completed so far, and will be completed in June 2015. To date 200 2-year interviews have been completed, with an expected completion date of June 2016. 

Output

Published papers:

1.      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.

2.      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.

3.      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 doi:10.1186/2050-6511-15-17

4.      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.

5.      Nielsen, S., Lintzeris, N., Bruno, R., Campbell, G., Larance, B., Hoban, B., Hall, W., Cohen, M., & Degenhardt, L. (2014). Benzodiazepine use amongst chronic pain patients prescribed opioids: associations with pain, physical and mental health and health service utilization. Pain Medicine. doi: 10.1111/pme.12594

6.      Campbell, G., Nielsen, S., Bruno, R., Lintzeris, N., Cohen, M., Hall, W., Larance, B., Mattick, R.P., & Degenhardt, L. (in press accepted November 5th 2014). The Pain and Opioids IN Treatment (POINT) study: Characteristics of a cohort using opioids to manage chronic non-cancer pain. Pain.

7.      Degenhardt, L., Lintzeris, N., Campbell, G., Bruno, R., Cohen, M., Farrell, M., & Hall, W., (in press accepted November 20th 2014). Experience of adjunctive cannabis use for chronic non-cancer pain: Findings from the Pain and Opioids IN Treatment (POINT) study. Drug and Alcohol Dependence.

Presentations:

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

10.     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.

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

12.     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.

13.     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.

14.     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.

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.

Benefits

This project will be 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 to mortality. This study will be 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.

The study will 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.

Currently, the evidence base for the regulation and monitoring of opioid analgesics is weak. Regulators across jurisdictions currently 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.

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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