Comparing rates and characteristics of harms across different pharmaceutical opioids

Similar to other high-income countries, Australian opioid-related mortality has almost doubled in the past decade, and the majority of the deaths are pharmaceutical opioid-related. Despite common extramedical use, few studies examine the relative harms associated with different pharmaceutical opioids.

This study aimed to describe rates and characteristics of harms related to commonly prescribed pharmaceutical opioids such as buprenorphine, codeine, fentanyl, oxycodone, oxycodone-naloxone, morphine, pethidine, tramadol, and tapentadol.

We examined ambulance attendance cases where recent extramedical (i.e. over- or inappropriate) use of a pharmaceutical opioid significantly contributed to the reason for the ambulance attendance.

This study represents one of the most detailed population-level examinations of pharmaceutical opioid-related harm in Australia. Distinct patterns of harms were observed for different opioids. These highlight the need to consider factors such as the formulation and the context of use to develop nuanced responses to reduce pharmaceutical opioid-related harm.

The protocol , quantitative findings and qualitative findings for this project have been published as peer-reviewed journal articles.

This work has also been presented at various conferences such as Addictions in Lisbon, the Australasian Professional Society on Alcohol and other Drugs (APSAD ) in Hobart, Society of Hospital Pharmacists of Australia (SHPA ) Gold Coast, the Victorian Institute of Forensic Medicine (VIFM ), and John Hopkins University.

We are currently conducting similar work on comparing pharmaceutical opioid-related overdoses that present to emergency departments.

Media - ‘Highest rates of harm were observed with codeine’

ABC Radio – 'Study: Half of opioid overdoses aren’t an accident'

Monash Lens'Prescription opioids both a blessing and a curse'

Featured publications

Wilson J, Lam T, Scott D, Crossin R, Matthews S, Smith K, Lubman DI & Nielsen S. 2020. 'Extreme personal stress' and 'a lot of pain': Exploring the physical, mental and social contexts of extramedical pharmaceutical opioid use in Australian paramedic case descriptions. Drug and Alcohol Review. 10.1111/dar.13118

Nielsen S, Crossin R, Middleton M, Lam T, Wilson J, Scott D, Martin C, Smith K, Lubman DI. 2020. Comparing rates
and characteristics of ambulance attendances related to extramedical use of pharmaceutical opioids in Victoria, Australia from 2013-2018. Addiction10.1111/add.14896

Nielsen S, Crossin R, Middleton M, Martin C, Wilson J, Lam T, Scott D, Smith K, Lubman DI. 2019. Comparing rates and characteristics of ambulance attendances related to extramedical use of pharmaceutical opioids in Australia: a protocol for a retrospective observational study. BMJ Open, 9 (5): e029170. 10.1136/bmjopen-2019-029170

Conference posters

The Society for Hospital Pharmacists (SHPA) 2019 - Nielsen, S.

The Australiasian Professional Society on Alcohol & other Drugs (APSAD) 2019 - Wilson, J.

Project Funder: This project was funded by an untied educational grant from Seqirus Pty Ltd.

Project Partners: Ambulance Victoria, Victoria Injury Surveillance Unit (VISU)

Project staff:

Team for the ambulance attendances work. 

(L-R): A/Prof Suzanne Nielsen, Dr Rose Crossin, Melissa Middleton

Dr Tina Lam, Dr James Wilson, Dr Debbie Scott,

Cathy Martin,  Prof Karen Smith, & Prof Dan Lubman