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POINT Study (Pain and Opioids IN Treatment)

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

National Health and Medical Research Council

Drug Type:
Project Members: 
image - Richard Mattick
Honorary Professor
Ph 02 9385 0333
image - Briony Larance Square
Adjunct Senior Lecturer
Ph 02 9385 0333
image - Headshot Nielsen 2017 1cropped 0
Dr Suzanne Nielsen
Senior Research Fellow
image - Gab Campbell
Research Fellow
Ph 02 9385 0286
Associate Professor
Ph +61 (2) 9385 3379
Professor Wayne Hall
Adjunct Professor
image - Michael Farrell 0
Director
Ph EA Tori Barnes: 02 9385 0292 / t.barnes@unsw.edu.au
Dr Raimondo Bruno
Adjunct Associate Professor
Associate Professor
Ph 02 9385 0333
image - Tom Santo
Post-Doctoral Research Fellow
image - Hopkins Ria Headshot
Senior Research Officer
Ph +61-2-9065-7831
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. 

Project Collaborators: External: 

A/Prof Fiona Blyth (Sydney University)

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

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

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 were 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

In July 2016, NHMRC awarded funding for the project: Pharmaceutical opioids for chronic non-cancer pain: Evaluating health outcomes and economic impact over five years. The four-year study is an extension of POINT  and is expected to conclude in 2019, with a final report due in 2020. POINT II started January 2016 with participants completing a 30-45 minute interview over the phone. At the conclusion of 2016, interviews had been conducted with 1,210 participants (80% of the sample). Four year interviews were initiated in January 2017 and 1,206 have been completed thus far, again reaching 80%. Five year interviews will begin in January 2018.

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., (2015). 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. (2016). Sleep quality among people living with chronic non-cancer pain: Findings from the Pain and Opioids IN Treatment (POINT) cohort. Clinical Journal of Pain 32(5), 380-387.
  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. (2016). Prevalence and correlates of suicidal thoughts and suicide attempts in people prescribed pharmaceutical opioids for chronic pain. Clinical Journal of Pain 32(4), 292-301.
  15. Peacock, A., Degenhardt, L., Campbell, G., Larance, B., Nielsen, S., Hall, W., Mattick, R.P. M. & Bruno, R (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 Physician, 19(3), E421-34.
  16. Nielsen, S., Campbell, G., Peacock, A., Smith, K., Bruno, R., Hall, W., Cohen, M. & Degenhardt, L. (2016). Health service utilisation by people living with chronic non-cancer pain: findings from the Pain and Opioids IN Treatment (POINT) study. Australian Health Review, 40, 490–499.
  17. Nielsen, S., Degenhardt, L. Hoban, B. & Gisev, N. (2015). A synthesis of oral morphine equivalents (OME) for opioid utilisation studies. Pharmacoepidemiology and Drug Safety, 25(6):733-7.
  18. Larance, B., Campbell, G., Peacock, A., Lintzeris, N., Bruno, R., Farrell, M., & Degenhardt, L (2016). Alcohol use disorders, risky drinking and adverse events among chronic non-cancer pain patients receiving opioid therapy. Drug and Alcohol Dependence, 162, 79-87.
  19. Campbell, G., Bruno, R., Blyth, F., Dobbins, T., Hall, W, Farrell, M., Nielsen, S., Larance, B., Cohen, M., Lintzeris, N., Mattick, R., Degenhardt, L., (2016). Defining problematic pharmaceutical opioid use among people prescribed opioids for chronic non-cancer pain: do different measures identify the same patients? Pain, 157(7), 1489-1498.
  20. Peacock, A., Nielsen, S., Bruno, R., Campbell, G., Larance, B. & Degenhardt, L. (2016). Geographic variation in use and perceived barriers to access of health services for people with chronic non-cancer pain in Australia. Pain Medicine, 17(11), 2003-2016.
  21. Nielsen S, Gisev N, Bruno, R , Hall W, Cohen M, Larance B, Campbell G, Shanahan M, Blyth F, Lintzeris N, Pearson S, Mattick R, Degenhardt L (2017). Defined Daily Doses (DDD) do not accurately reflect opioid doses used in contemporary chronic pain treatment. Pharmacoepidemiology and Drug Safety, 26(5),587-591.
  22. Nielsen, S., Peacock, A., Lintzeris, N., Bruno, R., Larance, B., Degenhardt, L. (Epub ahead of print, 2017). Knowledge of opioid overdose and attitudes to supply of naloxone for opioid overdose reversal among people with chronic non-cancer pain prescribed opioids. Pain Medicine.
  23. Larance, B., Degenhardt, l., Peacock, A., Gisev, N., Mattick, R., Colledge, S & Campbell, G. (2017). Pharmaceutical opioid use and harm in Australia: The need for proactive and preventative responses. Commentary for Drug Alcohol Rev. doi:10.1111/dar.12617
  24. Larance, B., Campbell, G., Moore T., Nielsen, S., Bruno, R., Lintzeris, N., Cohen, M., Hall, W., Mattick, R. P., O’Donnell, C & Degenhardt, L. (Accepted 2017). Concerns and help-seeking among patients using opioids for management of chronic non-cancer pain. Pain Medicine.
  25. Campbell, G., Degenhardt L. (2017). Long-term opioid use in patients with chronic non-cancer pain. Who is experiencing the problems? Medicine Today. Prescription opioid Misuse Supplement, 18(3 Suppl): 10-13.
  26. Nielsen, S., Peacock, A., Lintzeris, N., Bruno, R., Larance, B., Degenhardt, L (2017). Knowledge of opioid overdose and attitudes to supply of take-home naloxone among people with chronic noncancer pain prescribed opioids. Pain Medicine, 19(3), 533-540.
  27. Larance, B. Degenhardt, L., Peacock, A., Gisev, N., Mattick, R., Colledge, S., & Campbell, G. (2018). Pharmaceutical opioid use and harm in Australia: The need for proactive and preventative responses. Drug and Alcohol Review, 37, S203-S205.
  28. Larance, B., Campbell, G., Moore, T., O’Donnell, C., Nielsen, S., Bruno, R., Lintzeris, N., Hall, W., & Degenhardt, L. (2018). Help-seeking for problematic opioid use among people with chronic non-cancer pain. Pain Medicine. doi: 10.1093/pm/pny078. 
  29. Campbell, G., Hall, W., Peacock, A., Lintzeris, N., Bruno, R., Larance, B., Nielsen, S., Cohen, M., Chan, G., Mattick, R.P., Blyth, F., Shanahan, M., Dobbins, T., Farrell, M., & Degenhardt, L. (2018). Cannabis use, pain and prescription opioid use in people living with chronic non-cancer pain: Findings from four years of follow-up of the POINT cohort. The Lancet Public Health, 3(7), e341-e350.
  30. Campbell G, Hall W, Degenhardt L, Dobbins T, Farrell M. (2018) Cannabis use and non-cancer chronic pain - Authors' reply. The Lancet Public Health, 3(10): e469.
  31. Campbell, G., Larance, B., Gisev, N., Pearson, S., Lintzeris, N., & Degenhardt, L. (2019). Regulatory and other responses to the pharmaceutical opioid problem. MJA, 210, doi: 10.5694/mja2.12047.
  32. Gisev, N., Nielsen, S., Campbell, G., Santo Jr, T., Mant, A., Bruno, R., Cohen, M., Hall, W., Larance, B., Lintzeris, N., Farrell, M., & Degenhardt, L. (2019). Antidepressant use among a cohort of people prescribed opioids for chronic non-cancer pain. Pain Medicine. doi: 10.1093/pm/pnz009.
  33. Gisev, N., Campbell, G., Lalic, S., Nielsen, S., Larney, S., Peacock, A., Pearson, S., & Degenhardt, L. (in press). Current pharmaceutical opioid access, use and problems in Australasian jurisdictions. Current Psychiatry Reports.
  34. Gisev, N., Nielsen, S., Campbell, G., Santo, T., Mant, A., Bruno, R., Cohen, M., Hall, W. D., Larance, B., Lintzeris, N., Farrell, M., & Degenhardt, L. (2019). Antidepressant Use Among People Prescribed Opioids for Chronic Noncancer Pain. Pain Medicine, 20(12), 2450–2458. https://doi.org/10.1093/pm/pnz009.
  35. Lintzeris, N., Santo Jr, T., Nielsen, S., Degenhardt, L., & Campbell, G. (2019). Estimating CDC-defined overdose risk in people prescribed opioids for chronic non-cancer pain: Implications for naloxone provision. Internal Medicine Journal, 49(8), 1054. 
  36. Nielsen, S., Gisev, N., Leung, J., Clare, P., Bruno, R., Lintzeris, N., Larance, B., Blyth, F., Hall, W., Cohen, M., Degenhardt, L., Farrell, M., & Campbell, G. (2021). Clinical correlates and outcomes associated with pregabalin use among people prescribed opioids for chronic non‐cancer pain: A five‐year prospective cohort study. British Journal of Clinical Pharmacology, 87(8), 3092–3104. https://doi.org/10.1111/bcp.14715.
  37. Degenhardt, L., Hungerford, P., Nielsen, S., Bruno, R., Larance, B., Clare, P. J., Dobbins, T., Hall, W., Cohen, M., Blyth, F., Lintzeris, N., Farrell, M., & Campbell, G. (2021). Pharmaceutical Opioid Use Patterns and Indicators of Extramedical Use and Harm in Adults With Chronic Noncancer Pain, 2012-2018. JAMA Network Open, 4(4), e213059–e213059. https://doi.org/10.1001/jamanetworkopen.2021.3059.
  38. Hopkins, R. E., Campbell, G., Degenhardt, L., Nielsen, S., Blyth, F., Cohen, M., & Gisev, N. (2022). Use of pharmacological and nonpharmacological treatments for chronic noncancer pain among people using opioids: A longitudinal cohort study. PAIN, 163(6). https://journals.lww.com/pain/Fulltext/2022/06000/Use_of_pharmacological....
  39. Santo Jr, T., Campbell, G., Gisev, N., & Degenhardt, L. (2022). Exposure to childhood trauma increases risk of opioid use disorder among people prescribed opioids for chronic non-cancer pain. Drug and Alcohol Dependence, 230, 109199. https://doi.org/10.1016/j.drugalcdep.2021.109199.
  40. Hopkins, R. E., Campbell, G., Degenhardt, L., Lintzeris, N., Larance, B., Nielsen, S., & Gisev, N. (2022). Self-reported challenges obtaining ongoing prescription opioids among Australians with chronic non-cancer pain. International Journal of Drug Policy, 105, 103708. https://doi.org/10.1016/j.drugpo.2022.103708. 

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
  12. Larance, B. Pharmaceutical opioid use in Australia: Use, misuse and unintended consequences.  Macquarie University Human Sciences Perspective Workshop: A Day on Drugs: What's the problem and how to reduce it, Sydney, 23 September 2015.
  13. Larance, B. (2016) The use and unintended consequences of pharmaceutical opioids in Australia: How do we measure problematic use and what is the role of abuse deterrent formulations? Australian Pain Society Conference 2016, 14 March 2016, Perth, Australia
  14. Larance, B. (2016) The complexities, comorbidities and consequences of pharmaceutical opioids: an update on current Australian research. Australian and New Zealand College of Anaesthetists Annual Scientific Meeting, 2 May 2016, Auckland.
  15. Nielsen S and Gill T (2016) Problematic use of prescription medication: integrating research findings into practice approaches. NADA conference June 7, 2016
  16. Larance B. (2016) The complexities, comorbidities and consequences of pharmaceutical opioids: an update on current Australian research. Drug and Alcohol Nurses Australia Conference. Sydney, 3 September 2016
  17. Nielsen S. Overview of national trends relating to opioid prescribing: challenges and opportunities. NADA Forum. Responding to pharmaceutical opioid dependence in the NGO sector (Invited speaker). June 9, 2017 Sydney.
  18. Nielsen S. Pharmaceutical Drugs: Use, Harms and Treatment Responses for Dependence. Central and Eastern Sydney Primary Health Network Continuing Professional Development Evening for GPs, Practice Nurses, Allied Health Professionals. May 4, 2017. (Invited speaker)
  19. Nielsen S. Responding to addiction in community pharmacy. Victorian Pharmacy Conference, Pharmaceutical Society of Australia (Invited speaker). Melbourne, April 29, 2017
  20. Nielsen S. Prescription and over the counter medications: Trends and treatment responses. International Medicine in Addiction Conference. Sydney. March 24, 2017 (Invited Speaker)

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
  15. Nielsen S, Peacock A, Lintzeris N, Bruno R, Larance B and Degenhardt L. Overdose knowledge and perceptions of take-home naloxone for patients with chronic non-cancer pain. Australasian Professional Society on Alcohol and other Drugs Conference; November 2 2016; Sydney, Australia.
  16. Hoban B, Gisev N, Nielsen S, Larance B, Degenhardt L. Sedative load in chronic non-cancer pain. National Drug and Alcohol Research Centre seminar series. Sydney, March 2017.
  17. Campbell, R. Bruno, M. Cohen, W. Hall, S. Nielsen, N. Lintzeris, B. Larance, R. P. Mattick, M. Farrell, L. Degenhardt. Defining problematic pharmaceutical opioid use among people prescribed opioids for chronic non-cancer pain: different measures, same patients? Australian Pain Society Conference. Adelaide, April 2017.
  18. Campbell, G., Nielsen, S., Lintzeris, N., Bruno, R., Peacock, A., Chan, G., Larance, B., Cohen, M., Farrell, M., Hall, W., & Degenhardt, L. Cannabis use among people prescribed opioids for chronic non-cancer pain: observations from the POINT cohort. NDARC Annual Symposium. October 2017, University of New South Wales.
  19. Campbell, G., Nielsen, S., Lintzeris, N., Bruno, Raimondo., Peacock, A., Chan, G., Larance, B., Cohen, M., Farrell, M., Hall, Wayne., & Degenhardt, L. Cannabis use among people prescribe opioids for chronic non-cancer pain: observations from the POINT cohort. Symposium presentation at the Australian Professional Society on Alcohol and other Drugs. Melbourne, November, 2017.
  20. Santo, Thomas, Briony Larance, Raimondo Bruno, et al. Correlates of Indicators of Potential Extra-Medical Opioid Use in People Prescribed Opioids for Chronic Non-Cancer Pain (Oral presentation). Australasian Professional Society on Alcohol & other Drugs (APSAD), Hobart 2019. 

  21. Hopkins RE, Campbell G, Degenhardt L, Hungerford P, Clare P, Gisev N. Health service utilisation by people living with chronic non-cancer pain whilst using opioids: A 5-year prospective observational study. National Drug and Alcohol Research Centre 2020 Annual Symposium. 5, 12, 19, 26 November 2020. Virtual. 

  22. Santo, Thomas, Gabrielle Campbell, Natasa Gisev, & Louisa Degenhardt. Exposure to childhood trauma increases risk of opioid use disorder among people prescribed opioids for chronic non-cancer pain (Oral Presentation). Australasian Professional Society on Alcohol & other Drugs (APSAD), Virtual 2021. 

  23. Hopkins RE, Campbell G, Degenhardt L, Gisev N. Patient-reported difficulties accessing pharmaceutical opioid prescriptions among Australians with chronic non-cancer pain. Australasian Professional Society on Alcohol & other Drugs (APSAD) 2021 Scientific Alcohol and Drug Conference. 7-10 November 2021. Virtual. 

  24. Hopkins RE, Campbell G, Degenhardt L, Gisev N. Patient-reported difficulties accessing pharmaceutical opioid prescriptions among Australians with chronic non-cancer pain. National Drug and Alcohol Research Centre 2021 Annual Symposium. 20-21 October 2021. Virtual. 

  25. Hopkins RE, Campbell G, Degenhardt L, Nielsen S, Blyth F, Cohen M, Gisev N. Use of pharmacological and non-pharmacological treatments for chronic non-cancer pain among people using opioids: A longitudinal cohort study. International Association for the Study of Pain (IASP) 2021 World Congress on Pain. 9-11 June & 16-18 June 2021. Virtual.  

  26. Hopkins RE, Campbell G, Degenhardt L, Hungerford P, Clare P, Gisev N. Health service and medicine use by people taking opioids for chronic non-cancer pain: A 5-year prospective observational study. Australian Pain Society 41st Annual Scientific Meeting. 19-20 April 2021. Virtual. 

  27. Hopkins RE, Campbell G, Degenhardt L, Hungerford P, Clare P, Gisev N. Health service utilisation by people living with chronic non-cancer pain whilst using opioids: A 5-year prospective observational study. National Drug and Alcohol Research Centre 2020 Higher Degree by Research Showcase. 3 September 2021. Virtual. 

  28. Hopkins RE, Campbell G, Degenhardt L, Nielsen S, Blyth F, Cohen M, Gisev N. Use of pharmacological and non-pharmacological treatments for chronic non-cancer pain among people using opioids: A longitudinal cohort study. Health Services Research Association of Australia and New Zealand (HSRAANZ) 12th Health Services Research Conference. 30 November-2 December 2022 (Accepted). Sydney, Australia 

  29. Hopkins RE, Campbell G, Degenhardt L, Gisev N. Identifying and addressing issues in access to health services among people using opioids for chronic pain: A 3-minute thesis. Health Services Research Association of Australia and New Zealand (HSRAANZ) 12th Health Services Research Conference. 30 November-2 December 2022 (Accepted). Sydney, Australia 

  30. Hopkins RE, Campbell G, Degenhardt L, Gisev N. Patient-reported difficulties accessing pharmaceutical opioid prescriptions among Australians with chronic non-cancer pain. Health Services Research Association of Australia and New Zealand (HSRAANZ) 12th Health Services Research Conference. 30 November-2 December 2022 (Accepted). Sydney, Australia 

  31. Hopkins RE, Campbell G, Degenhardt L, Lintzeris N, Larance B, Nielsen S, Gisev N. Self-reported challenges obtaining ongoing prescription opioids among Australians with chronic non-cancer pain. Lisbon Addictions European Conference on Addictive Behaviours and Dependence. 23-25 November 2022. (Accepted) Lisbon, Portugal. 

  32. Hopkins RE, Campbell G, Degenhardt L, Lintzeris N, Larance B, Nielsen S, Gisev N. Self-reported challenges obtaining ongoing prescription opioids among Australians with chronic non-cancer pain. International Society for the Study of Drug Policy (ISSDP) 15th Annual Conference. 22 November 2022. (Accepted) Lisbon, Portugal. 

  33. Hopkins RE, Campbell G, Degenhardt L, Nielsen S, Blyth F, Cohen M, Gisev N. Use of pharmacological and non-pharmacological treatments for chronic non-cancer pain among people using opioids: A longitudinal cohort study. International Society for Pharmacoepidemiology (ISPE) 38th International Conference on Pharmacoepidemiology and Therapeutic Risk Management. 24-28 August 2022. (Accepted) Copenhagen, Denmark.  

  34. Hopkins RE, Campbell G, Degenhardt L, Lintzeris N, Larance B, Nielsen S, Gisev N. Self-reported challenges obtaining ongoing prescription opioids among Australians with chronic non-cancer pain. International Society for Pharmacoepidemiology (ISPE) 38th International Conference on Pharmacoepidemiology and Therapeutic Risk Management. 24-28 August 2022. (Accepted) Copenhagen, Denmark. 

  35. Hopkins RE, Campbell G, Degenhardt L, Lintzeris N, Larance B, Nielsen S, Gisev N. Self-reported challenges obtaining ongoing prescription opioids among Australians with chronic non-cancer pain. Medicines Intelligence Centre of Research Excellence (MI-CRE) 2022 Research Symposium and Policy Forum. 27-29 April 2022. Sydney, Australia. (Prize: Best Debut/PhD Presentation.) 

  36. Hopkins RE, Campbell G, Degenhardt L, Gisev N. Understanding the accessibility of pain management and other health services by Australians living with chronic pain. Australian Pain Society 42nd Annual Scientific Meeting. 10-13 April 2022. Hobart, Australia. 

  37. Hopkins RE, Campbell G, Degenhardt L, Lintzeris N, Larance B, Nielsen S, Gisev N. Self-reported challenges obtaining ongoing prescription opioids among Australians with chronic non-cancer pain. Australian Pain Society 42nd Annual Scientific Meeting. 10-13 April 2022. Hobart, Australia. 

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. 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. Benzodiazepine use amongst a sample of chronic pain patients prescribed opioids.  College on Problems of Drug Dependence 76th Annual Meeting; San Juan, Puerto Rico, 2014.
  3. Campbell, G. 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. 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. 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.
  6. Moodley, R., Lintzeris, N., Campbell, G., Bruno, R., Larance, B., Nielsen, S., & Degenhardt, L. 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. 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. 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, June 2015..
  9. Larance, B., Peacock, A., Campbell, G. Bruno, R., Mattick, R., Nielsen, S., Cohen, M., Smith, K., Degenhardt, L. 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, June 2015.
  11. Degenhardt, L., Lintzeris, N., Campbell, G., Bruno, R., Cohen, M., Farrell, M., & Hall, W. 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, June 2015.
  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, University of New South Wales.
  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, University of New South Wales.
  16. G. Campbell, R. Bruno, M. Cohen, W. Hall, S. Nielsen, N. Lintzeris, B. Larance, R. P. Mattick, M. Farrell, L. Degenhardt. Defining problematic pharmaceutical opioid use among people prescribed opioids for chronic non-cancer pain: different measures, same patients? Poster presentation CPDD Conference, 2016.
  17. Nielsen, S., Peacock, A., Lintzeris, N., Bruno, R., Larance, B., Degenhardt, L. Knowledge of opioid overdose and attitudes towards naloxone among chronic pain patients prescribed opioids. IASP, 2016.
  18. G. Campbell, R. Bruno, M. Cohen, W. Hall, S. Nielsen, N. Lintzeris, B. Larance, R. P. Mattick, M. Farrell, L. Degenhardt. Defining problematic pharmaceutical opioid use among people prescribed opioids for chronic non-cancer pain: different measures, same patients? Poster presentation NDARC Annual Symposium, September 2016, University of New South Wales.
  19. Moore, T., O’Donnell, C., Degenhardt, L., Campbell, G., Nielsen, S., & Larance, B. Physical health and utilisation of alcohol and other drug treatment among a sample of chronic non-cancer pain patients dependent on their opioid medication Poster presentation NDARC Annual Symposium, September 2016, University of New South Wales.
  20. G. Campbell, R. Bruno, M. Cohen, W. Hall, S. Nielsen, N. Lintzeris, B. Larance, R. P. Mattick, M. Farrell, L. Degenhardt. Defining problematic pharmaceutical opioid use among people prescribed opioids for chronic non-cancer pain: different measures, same patients? APSAD, November 2016.
  21. Moore, T., O’Donnell, C., Degenhardt, L., Campbell, G., Nielsen, S., & Larance, B. Physical health and utilisation of alcohol and other drug treatment among a sample of chronic non-cancer pain patients dependent on their opioid medication Poster presentation APSAD November 2016.
  22. Hoban B, Gisev N, Nielsen S, Larance B, Bruno R, Lintzeris N, Degenhardt L. Sedative load and sleep problems in people with chronic non-cancer pain prescribed opioids (Oral rapid communication presentation and poster). Australian Pain Society Conference. Adelaide, April 2017.
  23. Hoban B, Nielsen S, Larance B, Gisev N, Degenhardt L. The medication quantification scale and associations with adverse events in people with chronic non-cancer pain prescribed opioids (poster). Australian Pain Society Conference. Adelaide, April 2017.
  24. Campbell, G., Larance, B., Nielsen, S., Moore, T. O’Donnell, C & Degenhardt, L. Patient concerns and help-seeking for problems with opioid medications for chronic non-cancer pain (poster). College of Problems of Drug Dependence (CPDD), Montreal, June 2017.
  25. Campbell, G., Larance, B., Nielsen, S., Moore, T. O’Donnell, C & Degenhardt, L. Patient concerns and help-seeking for problems with opioid medications for chronic non-cancer pain (poster). National Institute on Drug Abuse (NIDA) International Forum, Montreal, June 2017.
  26. Garton, A., Chan, G., Campbell, G., Larance, B., Nielsen, S., Lynch, S. & Degenhardt, L. Characteristics of chronic non-cancer pain patients prescribed opioid medication based on pain severity (poster). NDARC Annual Symposium, November 2017, University of New South Wales.
  27. Lynch, S., Campbell, G., Larance, B., Nielsen, S., Garton, A. & Degenhardt, L. Understanding the relationship between pain catastrophizing and medication aberrant behaviours, amongst people prescribed opioids for chronic non-cancer pain (poster). NDARC Annual Symposium, November 2017, University of New South Wales.
  28. Santo, Thomas, Briony Larance, Raimondo Bruno, et al. Correlates of Indicators of Potential Extra-Medical Opioid Use in People Prescribed Opioids for Chronic Non-Cancer Pain (Poster). College on Problems of Drug Dependence (CPDD), Virtual 2020.  
  29. Santo, Thomas, Briony Larance, Raimondo Bruno, et al. Correlates of Indicators of Potential Extra-Medical Opioid Use in People Prescribed Opioids for Chronic Non-Cancer Pain (Poster). National Drug & Alcohol Research Centre (NDARC) Symposium, Sydney 2019.  

  30. Santo, Thomas, Briony Larance, Raimondo Bruno, et al. Correlates of Indicators of Potential Extra-Medical Opioid Use in People Prescribed Opioids for Chronic Non-Cancer Pain (Poster). Sydney Partnership for Health, Education, Research & Enterprise (SPHERE), Sydney 2019. 

  31. Santo, Thomas, Gabrielle Campbell, Natasa Gisev, & Louisa Degenhardt. Exposure to childhood trauma increases risk of opioid use disorder among people prescribed opioids for chronic non-cancer pain (Poster). National Drug & Alcohol Research Centre (NDARC) Symposium, Virtual 2021. 

Other outputs

  1. Nielsen, S., Degenhardt, L., Hoban, B., & Gisev, N. (2014). Comparing opioids: A guide to estimating oral morphine equivalents (OME) in research. NDARC Technical Report No. 329. Sydney: National Drug and Alcohol Research Centre, UNSW Australia.
  2. Campbell, G., Degenhardt L. (2017) Long-term opioid use in patients with chronic non-cancer pain. Who is experiencing the problems? Medicine Today. Prescription opioid Misuse Supplement – 2nd March 2017
  3. Campbell, G. Long-term opioid use in patients with chronic noncancer pain. Connections, June, 2017
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.

Drug Type: 
Project Status: 
Current