This project will provide crucial new data on the nature and trajectories of Pharmaceutical Opioid (PO) use through the study and follow-up of two very different and yet extremely important groups of pharmaceutical opioid users: those attending treatment services for PO dependence, and people who inject drugs (PWID). These two groups are likely to account for a significant proportion of pharmaceutical opioid consumption and a disproportionate amount of harm related to pharmaceutical opioids in Australia.
Associate Professor Nicholas Lintzeris
Drug and Alcohol Services, South East Sydney and Illawarra Area Health
Professor Milton Cohen
St Vincent's Hospital, Sydney
Associate Professor Raimondo Bruno
University of Tasmania
Dr Jennifer Johnson
University Centre for Rural Health, Lismore
Drug and Alcohol Clinical Services, Hunter New England Local Health District
Sydney Medically Supervised Injecting Centre
Incidence of pharmaceutical opioid-related problems appears to be markedly increasing in Australia, as evidenced by increases in hospital poisoning presentations for pharmaceutical opioids compared to heroin (Australian Institute of Health and Welfare, 2011, Stafford and Burns, 2011). From 1992-2007, the number of opioid prescriptions in Australia increased by around 300% (Leong et al., 2009). This increase in prescribing has been accompanied by an increase problematic use and opioid-related harms including hospital ED presentations. An estimated 10% of hospital D&A CL services are for patients whose primary substance use is pharmaceutical opioids (e.g. OTC codeine (Nurofen plus), oxycodone).
Problematic pharmaceutical opioid use is associated with significant public health burden, yet the full extent harms and outcomes amongst different populations of pharmaceutical opioid users has not been quantified in Australia. The identified harms include dependence, overdose, injection-related injuries and diseases, and mortality (Roxburgh et al., 2011, Degenhardt et al., 2008, Nielsen et al., 2007). Treatment needs for these groups are not well understood; demographic characteristics appear different from traditional AOD samples (Nielsen, 2011), there is a limited evidence base as to the effectiveness of current treatments for PO dependence, and illicit PO use may reflect unmet treatment needs. Pharmaceutical opioid users with acute and/or chronic pain present specific clinical challenges with regards to medication selection, monitoring of aberrant behaviours (e.g. poor medication control, dose escalation, diversion) and responses to non-adherence.
To provide the first detailed studies of two diverse groups of pharmaceutical opioid users: people seeking treatment for pharmaceutical opioid dependence, and people who inject drugs (PWID), including a three month follow up to understand outcomes and interventions that are relevant to these distinct populations of pharmaceutical opioid users.
We will recruit two cohorts of people at risk of harms from prescribed opioids: the treatment cohort will be recruited from five Local Health Districts (LHDs); the PWID cohort will be recruited through existing studies at NDARC (Illicit Drug Reporting System (IDRS) and the post-marketing surveillance studies of Suboxone Film). Measures will be recorded at baseline and three month follow-up. The assessment will include demographics, substance use including pharmaceutical opioids, alcohol, illicit use of other pharmaceuticals and other illicit drug use, side effects of prescribed opioids, aberrant drug behaviours, physical health (including pain measures), medical conditions, pain, quality of life (WHOQOL), psychosocial functioning (SF12), mental health (depression, anxiety), and health service utilisation. Descriptive statistics will be used to describe baseline characteristics of each of the cohorts. Generalised estimating equations (GEE) and/or latent growth curve modelling (LGCM) will be used to examine predict later outcomes for each cohort.
Baseline and three-month data for both cohorts is completed, with 12- and 24-month data collection also completed for the Pharmaceutical Opioid Treatment cohort. Analyses for the treatment cohort study are underway.
Nielsen S, L. B., Lintzeris N, Holliday S, Vanderhaven M, Lattas G, Hordern A, Dunlop A, Haber P, Murnion B, Silsbury C, Johnson J, Demirkol A, Sadler C, Phung N, Burns L, Mattick R, Campbell G, Farrell M, Cohen M, Bruno, R, Hardy M, Brown A, Houseman J, Degenhardt L. (2015). An Australian cohort study of pharmaceutical opioid users in treatment. . Paper presented at the NIDA International Forum, Phoenix, USA.
Cooper S, Campbell G and Nielsen S. Stigma and social support in a cohort of pharmaceutical opioid users in treatment. Poster presentation. National Drug and Alcohol Research Centre Annual Symposium. September 12, 2016. Sydney
Vanderhaven M, Larney S, Nielsen S. Is pain associated with mental health for those in treatment for pharmaceutical opioid use? A prospective cohort study. 13th Annual Forensic Psychology Research Conference. October 27-28, 2015. Sydney
Lattas G, Larney S, Nielsen S. Comparing Post-Traumatic Stress Disorder Symptoms and Substance Use Among People Who Use Pharmaceutical Opioids and People Who Use Heroin. 13th Annual Forensic Psychology Research Conference. October 27-28, 2015. Sydney
Vanderhaven M, Larney S & Nielsen S. Examining the relationship between pain and mental health in pharmaceutical opioid users in treatment. Poster presentation. National Drug and Alcohol Research Centre Annual Symposium. September 15, 2015. Sydney
Lattas G, Larney S & Nielsen S. Examining the relationship between Post-Traumatic Stress Disorder (PTSD) and substance use in people who use pharmaceutical opioids compared with those who use heroin. Poster presentation. National Drug and Alcohol Research Centre Annual Symposium. September 15, 2015. Sydney
Nielsen S. Pharmaceutical opioid problems and changing treatment needs: An Australian perspective. September 7, 2015 . Ireland. (Invited public lecture)
Nielsen S, Larance B, Lintzeris N, Holliday S, Vanderhaven M, Hordern A, Dunlop, A., Haber, P., Murnion, B., Silsbury, C., Johnson, J., Demirkol, A., Sadler, C., Phung, N., Burns, L., Mattick, R., Campbell, G., Farrell, M., Cohen, M., Bruno, R., Brown, A,. Degenhardt, L. Pharmaceutical Opioid Dependence: Baseline characteristics from a cohort of treatment entrants. NDARC Annual Research Symposium, Sydney, September 2014.
Larance B, Nielsen S, Hordern A, Lintzeris N, Burns L, Mattick R, Campbell, G., Farrell, M., Cohen, M., Bruno, R., Brown, A., Johnson, J., Degenhardt, L.. Pharmaceutical opioid use and pain among people who inject drugs: Baseline findings from a prospective cohort study. NDARC Annual Research Symposium, Sydney, September 2014.
Nielsen S, Larance B, Lintzeris N, Holliday S, Vanderhaven M, Hordern A, Dunlop, A.,Haber, P., Murnion, B., Silsbury, C., Johnson, J., Demirkol, A., Sadler, C., Phung, N., Burns, L., Mattick, R., Campbell,. G., Farrell, M., Cohen, M., Bruno, R., Hardy, M., Brown, A., Houseman, J., Degenhardt, L. Seeking treatment for pharmaceutical opioid dependence: Baseline findings from an in-treatment cohort. Australasian Professional Society on Alcohol and other Drugs; Adelaide, 2014.
Larance B, Nielsen S, Hordern A, Lintzeris N, Burns L, Mattick R, Campbell, G., Farrell, M., Cohen, M., Bruno, R., Brown, A., Johnson, J., Degenhardt, L. Pharmaceutical opioid use and pain amongst people who inject drugs: Baseline findings from a prospective cohort study. Australasian Professional Society on Alcohol and other Drugs; Adelaide, 2014.
Understanding the health and service needs of diverse populations of pharmaceutical opioid users: Cohort studies of dependent users in treatment, and people who inject drugs, NDARC Technical Report Number 331 (2015).
Cooper S & Nielsen S (2016). Stigma and social support in pharmaceutical opioid treatment populations: a scoping review. The International Journal of Mental Health and Addiction. In Press (Accepted 04/11/16)
This will be the first study to prospectively follow up a two cohorts of PO dependent people in Australia to understand longer term patterns of use and associated outcomes for these groups.