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The POPPY II study: combating escalating harms associated with pharmaceutical opioid use in Australia

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Date Commenced:
01/2018
Expected Date of Completion:
12/2022
Project Supporters:

National Health and Medical Research Council (GNT1138442)

Drug Type:
Project Members: 
image - Natasa Gisev 5A %282%29
Scientia Fellow (Level C)
Ph 02 9385 0333
image - Sarah Larney
Adjunct Senior Lecturer
Ph +61 (2) 9385 0333
image - Richard Mattick
Honorary Professor
Ph 02 9385 0333
Project Main Description: 

This project uses linked administrative data to examine the patterns of use of prescribed opioids, quantify the risks of adverse outcomes, and examine the population-level impact of changes to regulation and subsidy of opioids.

Other investigators:  
Professor Sallie-Anne Pearson, Centre for Big Data Research in Health, UNSW Sydney
Associate Professor Timothy Dobbins, School of Population Health, UNSW Sydney
Professor David Currow, IMPACCT, Faculty of Health, University of Technology Sydney Professor Fiona Blyth, Concord Clinical School, The University of Sydney
Conjoint Professor Adrian Dunlop, School of Medicine and Public Health, Faculty of Health, The University of Newcastle
Professor Andrew Wilson, Menzies Centre for Health Policy, Faculty of Medicine and Health, The University of Sydney

Collaborators:
Dr Andrea Schaffer, Centre for Big Data Research in Health, UNSW Sydney
Dr Briony Larance, University of Wollongong
Dr Gabrielle Campbell, University of the Sunshine Coast
Dr Michael Coory, Therapeutic Goods Administration
Professor Milton Cohen, St Vincent’s Hospital
Professor Nicholas Buckley, University of Sydney
Professor Paul Haber, University of Sydney
Professor Rebecca Ivers, School of Population Health, UNSW Sydney

Rationale: 

Opioid prescribing has increased 15-fold in Australia in the past two decades, alongside increases in a range of opioid-related harms such as opioid dependence and overdose. However, despite concerns about increasing opioid use, extramedical use and harms, there is a lack of population-level evidence about the drivers of long-term prescribed opioid use, dependence, overdose and other harms.

Design and Method: 

This is a retrospective population-based cohort study of 3.5 million New South Wales (NSW) adult residents who initiated prescribed opioids between 2003-2018. The cohort was defined using Pharmaceutical Benefits Scheme dispensing records and is linked to a wide range of other datasets containing information on sociodemographic and clinical characteristics, health service use and adverse outcomes (eg, opioid dependence and non-fatal and fatal overdose). Analyses will initially examine patterns and predictors of prescribed opioid use and then apply more sophisticated regression and survival analysis to quantify the risks and risk factors of adverse outcomes associated with prescribed opioid use.

Progress/Update: 

The study protocol has been published (https://bmjopen.bmj.com/content/8/12/e025840).

Project data were received in mid-2020. All data cleaning has been conducted and the project is now in the data analysis/paper writing stage with several papers currently in various stages of submission. This includes work on profiling the cohort, defining opioid exposure, trajectories of opioid use, opioid prescribing patterns, and a range of outcome studies.

Output: 

Published papers

Gisev, N., Pearson, S., Dobbins, T., Currow, D., Blyth, F., Larney, S., Dunlop, A., Mattick, R.P., Wilson, A., & Degenhardt, L. (2018). Combating escalating harms associated with pharmaceutical opioid use in Australia: the POPPY II study protocol. BMJ Open, 8:e025840. doi: 10.1136/bmjopen-2018-025840

Conference abstracts

Gisev, N., Pearson, S.A., Dobbins, T., Buizen, L., Murphy, T., Wilson, A., Blyth, F., Dunlop, A., Larney, S., Currow, D.C., Mattick, R.P. Degenhardt, L. POPPY II Cohort Profile– a population-based linked cohort examining the course and outcomes of prescription opioid use in NSW, Australia, 2003-2018. Presented at the 37th International Conference on Pharmacoepidemiology & Therapeutic Risk Management. 23-25 August 2021.

Gisev, N., Pearson, S.A., Dobbins, T., Buizen, L., Murphy, T., Wilson, A., Blyth, F., Dunlop, A., Larney, S., Currow, D.C., Mattick, R.P. Degenhardt, L. POPPY II Cohort Profile– a population-based linked cohort examining the course and outcomes of prescription opioid use in NSW, Australia, 2003-2018. Presented at the 2021 Centre of Research Excellence in Medicines Intelligence Symposium and Policy Forum. 16 September 2021.

Gisev, N., Buizen, L., Schaffer, A., Daniels, B., Pearson, S.A., Dobbins, T., Blyth, F., Dunlop, A., Larney, S., Degenhardt, L. Long-term trajectories of prescription opioid use in Australia. Presented at the 2021 Centre of Research Excellence in Medicines Intelligence Symposium and Policy Forum. 16 September 2021.

Bharat, C., Barbieri, S., Dobbins, T., Larney, S., Gisev, N., Dunlop, A., Farrell, M., Degenhardt, L. Trends in prescription opioid dispensing among people with a history of opioid dependence: A retrospective study in New South Wales, Australia. Presented at the 2021 Centre of Research Excellence in Medicines Intelligence Symposium and Policy Forum. 16 September 2021.

Schaffer, A., Gisev, N., Degenhardt, L., Blyth, F., Buckley, N.A., Currow, D., Dobbins, T.A., Wilson, A., Pearson, S.A. Opioid prescribing patterns among medical practitioners in New South Wales, 2013-2018. Presented at the 2021 Centre of Research Excellence in Medicines Intelligence Symposium and Policy Forum. 16 September 2021.

Benefits: 

This is the most comprehensive post-marketing surveilance study of prescribed opioids undertaken in Australia, linking exposure and outcomes and examining risk factors for adverse outcomes of prescribed opioids. It will also demonstrate the capacity of analysis of routinely collected data to inform risks of opioid prescribing before problems develop. As such, this work has important translational promise, with direct relevance to regulatory authorities and agencies worldwide. It will provide evidence against which clinical guidelines in pain management can be evaluated.

Project Research Area: 
Drug Type: 
Project Status: 
Current