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 Suzi Nielsen (University of Sydney)
Dr Raimondo Bruno (University of Tasmania)
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.
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.
January 2013: 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 and over 6,500 fliers have been dispersed to 255 pharmacies resulting in 464 people (currently taking schedule 8 opioids for chronic pain) referred to the study. To date 238 baseline interviews and 58 3-month follow-ups assessments have been completed.
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.