Enabling evidence-informed policy to address Australia's opioid crisis

Investigators: Prof Suzanne Nielsen, Prof Simon Bell, Prof Grant Russell, Samanta Lalic, Dr Paul Sanfilippo, Georgia Richards, Prof Rachelle Buchbinder, A/Prof Nadine Andrew, A/Prof Christopher Pearce, Prof Dan Lubman, Dr Elizabeth Deveny, Dr Jenni Ilomaki, Dr Ting Xia, Monica Jung, Helena Cangadis-Douglass

Policies restricting opioid supply have recently been implemented to address rising opioid-related deaths in Australia, with little evidence of the impact of these policies. This study made significant advancements in our understanding of the impact of these opioid policy changes by leveraging the linkage of a unique primary care dataset with hospital data. We provided crucial evidence of a possible substitution effect following the recent implementation of the prescription drug monitoring program (PDMP). This work formed a formal Regulatory Impact Statement submitted to the Department of Health, contributing directly to recent changes to the Victorian PDMP which prompted the inclusion of pregabalin, gabapentin and tramadol in the PDMP from 3 July 2023 onwards.

We also found evidence of reduced opioid-related emergency department (ED) visits but also a short-term increase in ED visits related to other substances following the implementation of opioid policies in Victoria. This work serves as a foundation for further evaluation of various system-level policies and interventions on opioid use and harms. In addition, we performed one of the first studies worldwide to provide a detailed picture of opioid taper trajectories and identified a range of key patient-level factors associated with opioid prescribing and deprescribing, which brought into question current opinion-based practise in consensus guidelines. This has also informed the need for future research into how to most effectively taper opioids in clinical practice, including risk stratifying patients and identifying those who may benefit from additional support.

Project funder

NHMRC Ideas Grant

Publications

Cangadis-Douglass H, Jung M, Xia T, Buchbinder R, Lalic S, Russell G, Andrew N, Pearce C, Bell S, Ilomäki J & Nielsen S. (2022). Using primary care data to understand opioid prescribing, policy impacts and clinical outcomes: A protocol for the OPPICO study. Research in Social and Administrative Pharmacy, 18(12), 4127-4137. DOI: 10.1016/j.sapharm.2022.07.041

Nielsen S, Buchbinder R, Pearce C, Lubman D, Lalic S, Haas R, Picco L, Jung M, Cangadis-Douglass H, Ilomaki J, Bell S & Xia T. (2023). Cohort profile: Using primary care data to understand Opioid Prescribing, Policy Impacts and Clinical Outcomes (OPPICO) in Victoria, Australia.BMJ Open 2023, 13(5), e067746. DOI: 10.1136/bmjopen-2022-067746

Nielsen S, Picco L, Russell G, Pearce C, Andrew N, Lubman D, Bell S, Buchbinder R & Xia T. (2023). Changes in opioid and other analgesic prescribing following voluntary and mandatory prescription drug monitoring program implementation: A time series analysis of early outcomes. International Journal of Drug Policy, 117. DOI: 10.1016/j.drugpo.2023.104053

Xia T, Picco L, Lalic S, Buchbinder R, Bell JS, Andrew N, Lubman D, Pearce C & Nielsen S. (2023). Determining the Impact of Opioid Policy on Substance Use and Mental Health-Related Harms: Protocol for a Data Linkage Study. JMIR Res Protoc;12:e51825. DOI: 10.2196/51825

Picco L, Xia T, Bell JS, Pearce C, Buchbinder R, Lubman D & Nielsen S. (2023). Changes in opioid agonist treatment initiation among people prescribed opioids for pain following voluntary and mandatory prescription drug monitoring program implementation: A time series analysis. Drug Alcohol Review, 42(7):1639-1646. DOI: 10.1111/dar.13754. 

Jung M, Xia T, Ilomäki J, Pearce C & Nielsen S. (2024). Opioid characteristics and nonopioid interventions associated with successful opioid taper in patients with chronic noncancer pain. Pain, 165(6):1327-1335. DOI: 10.1097/j.pain.0000000000003133

Nielsen, S., & Xia, T. (2024). Interventions for reducing the prescribing of pharmaceutical opioids in Australia: are they effectively reducing opioid harm? The Medical Journal of Australia, 220(6), 311-312. DOI: 10.5694/mja2.52259

Xia T, Picco L, Buchbinder R, Haas R & Nielsen S. (2024). Association of state-level prescription drug monitoring program implementation with opioid prescribing transitions in primary care in Australia. Br J Clin Pharmacol., 90(4): 1162-1172. DOI:10.1111/bcp.15996.

Jung M, Xia T, Ilomäki J, Pearce C & Nielsen S. (2024). Trajectories of prescription opioid tapering in patients with chronic non-cancer pain: a retrospective cohort study, 2015-2020. Pain Med.,25(4):263-274. doi: 10.1093/pm/pnae002.