OBJECTIVE: To examine the predictors of persistent opioid use (\'persistence\') in people initiating opioids for non-cancer pain in Australian primary care.
METHODS: A retrospective cohort study.
METHODS: Australian primary care.
METHODS: People prescribed opioid analgesics between 2018-2022, identified through the Population Level Analysis and Reporting (POLAR) database.
METHODS: Persistence was defined as receiving opioid prescriptions for at least 90 days with a gap of less than 60 days between subsequent prescriptions. Multivariable logistic regression was used to examine the predictors of persistent opioid use.
RESULTS: The sample consisted of 343,023 people initiating opioids for non-cancer pain; of these, 16,527 (4.8%) developed persistent opioid use. Predictors of persistence included older age (≥75 vs 15-44 years: Adjusted odds ratio: 1.67, 95% CI: 1.58-1.78), concessional beneficiary status (1.78, 1.71-1.86), diagnosis of substance use disorder (1.44, 1.22-1.71) and chronic pain (2.05, 1.85-2.27), initiation of opioid therapy with buprenorphine (1.95, 1.73-2.20) and long-acting opioids (2.07, 1.90-2.25), provision of higher quantity of opioids prescribed at initiation (total OME of ≥ 750mg vs < 100mg: 7.75, 6.89-8.72), provision of repeat/refill opioid prescriptions at initiation (2.94, 2.77-3.12), and prescription of gabapentinoids (1.59, 1.50-1.68), benzodiazepines (1.43, 1.38-1.50) and z-drugs (e.g., zopiclone, zolpidem; 1.61, 1.46-1.78).
CONCLUSIONS: These findings add to the limited evidence of individual-level factors associated with persistent opioid use. Further research is needed to understand the clinical outcomes of persistent opioid use in people with these risk factors to support the safe and effective prescribing of opioids.

Introduction: Europe has seen a steady increase in the use of prescription opioids, especially in non-cancer indications. Epidemiological data on the patterns of use of opioids is required to optimize prescription. We aim to describe the patterns of opioid therapy initiation for non-cancer pain and characteristics of patients treated in a region with five million inhabitants in the period 2012 to 2018. Methods: Population-based retrospective cohort study of all adult patients initiating opioid therapy for non-cancer pain in the region of Valencia. We described patient characteristics at baseline and the characteristics of baseline and subsequent treatment initiation. We used multinominal regression models to identify individual factors associated with initiation. Results: A total of 957,080 patients initiated 1,509,488 opioid treatments (957,080 baseline initiations, 552,408 subsequent initiations). For baseline initiations, 738,749 were with tramadol (77.19%), 157,098 with codeine (16.41%) 58,436 (6.11%) with long-acting opioids, 1,518 (0.16%) with short-acting opioids and 1,279 (0.13%) with ultrafast drugs. When compared to tramadol, patients initiating with short-acting, long-acting and ultrafast opioids were more likely to be older and had more comorbidities, whereas initiators with codeine were more prone to be healthier and younger. Treatments lasting less than 7 days accounted for 41.82% of initiations, and 11.89% lasted more than 30 days. 19.55% of initiators with ultrafast fentanyl received more than 120 daily Morphine Milligram Equivalents (MME), and 16.12% of patients initiating with long-acting opioids were prescribed more than 90 daily MME (p < 0.001). Musculoskeletal indications accounted for 65.05% of opioid use. Overlap with benzodiazepines was observed in 24.73% of initiations, overlap with gabapentinoids was present in 11.04% of initiations with long-acting opioids and 28.39% of initiators with short-acting opioids used antipsychotics concomitantly. In subsequent initiations, 55.48% of treatments included three or more prescriptions (vs. 17.60% in baseline initiations) and risk of overlap was also increased. Conclusion: Opioids are initiated for a vast array of non-oncological indications, and, despite clinical guidelines, short-acting opioids are used marginally, and a significant number of patients is exposed to potentially high-risk patterns of initiation, such as treatments lasting more than 14 days, treatments surpassing 50 daily MMEs, initiating with long-acting opioids, or hazardous overlapping with other therapies.

UNASSIGNED: To examine differences in healthcare utilisation and costs associated with opioid prescriptions for non-cancer pain issued in primary care.
UNASSIGNED: A longitudinal, case-control study retrospectively examined Welsh healthcare data for the period 1 January 2005-31 December 2015. Data were extracted from the Secure Anonymised Information Linkage (SAIL) databank. Subjects, aged 18 years and over, were included if their primary care record contained at least one of six overarching pain diagnoses during the study period. Subjects were excluded if their record also contained a cancer diagnosis in that time or the year prior to the study period. Case subjects also received at least one prescription for an opioid analgesic. Controls were matched by gender, age, pain-diagnosis and socioeconomic deprivation. Healthcare use included primary care visits, emergency department (ED) and outpatient (OPD) attendances, inpatient (IP) admissions and length of stay. Cost analysis for healthcare utilisation used nationally derived unit costs for 2015. Differences between case and control subjects for resource use and costs were analysed and further stratified by gender, prescribing persistence (PP) and deprivation.
UNASSIGNED: Data from 3,286,215 individuals were examined with 657,243 receiving opioids. Case subjects averaged 5 times more primary care visits, 2.8 times more OPD attendances, 3 times more ED visits and twice as many IN admissions as controls. Prescription persistence over 6 months and greater deprivation were associated with significantly greater utilisation of healthcare resources. Opioid prescribing was associated with 69% greater average healthcare costs than in control subjects. National Health Service (NHS) healthcare service costs for people with common, pain-associated diagnoses, receiving opioid analgesics were estimated to be £0.9billion per year between 2005 and 2015.
UNASSIGNED: Receipt of opioid prescriptions was associated with significantly greater healthcare utilisation and accompanying costs in all sectors. Extended prescribing durations are particularly important to address and should be considered at the point of initiation.

Long-term prescription opioid use has been associated with adverse health outcomes, including opioid use disorder (OUD). We examined a population of opioid naïve individuals who initiated prescription opioids for non-cancer pain and investigated the associations between opioid prescription characteristics at initiation and time to treated OUD.
We conducted a retrospective population-based cohort study in Ontario, Canada among opioid naïve individuals aged 15 years and older dispensed an opioid for non-cancer pain between 2013 and 2016. We used the Narcotic Monitoring System to abstract opioid dispensing data. A multivariable Cox regression model was used to examine the association between average daily dose and time to treated OUD.
We identified 1,607,659 opioid-naïve individuals who initiated a prescription opioid within the study period. The incidence of treated OUD within the study period was 86 cases per 100,000 person-years. Compared to an average daily dose of <20 morphine milligrams equivalent (MME), higher average daily doses at initiation were associated with greater hazard of treated OUD, 20-50 MME (HR 1.11, 95% CI: 1.02, 1.21), >50-90 MME (HR 1.29, 95% CI: 1.16, 1.44), >90-150 MME (HR 1.29, 95% CI: 1.06, 1.56), >150-200 MME (HR 2.49, 95% CI: 1.54, 4.03) and >200 MME (HR 4.15, 95% CI: 2.89, 5.97). Long-acting formulations and days\' supply ≥11 days were also associated with greater hazard of treated OUD.
Prescription opioid characteristics at initiation are associated with risk of treated OUD, identifying potentially important and modifiable risk factors among people initiating opioids for non-cancer pain.

Background: Chronic non-cancer pain is a common cause of primary care physicians\' office visits. Objective: To determine the impact of adopting screening and monitoring measures in primary care settings on the illicit substance use behavior of patients receiving opioid analgesic prescriptions. Methods: This was a retrospective analysis of data on patients who were prescribed opioid analgesics for chronic non-cancer pain between 2014 and 2017 Q1 (i.e., first quarter of 2017). Study participants were patients who sought medical care at our academic primary care clinic practice that is part of an internal medicine residency program. Participants were adults (>18 years) who were considered eligible for opioid analgesics for chronic non-cancer pain. Interventions: (1) Rolling out of the chronic non-cancer pain management policy to clinic staff; (2) pain medication contracts with patients; (3) random urine drug screen (UDS) testing performed on patients during their clinic visits; 4) a didactics curriculum for internal medicine residents to highlight the key elements in utilizing and interpreting UDS results; (5) adding alerts to the electronic medical record that notifies clinic staff of discrepancy between patients\' prescribed medications and UDS findings, as well as for quick identification of patients who had violated a stipulation of the contract; (6) mandatory regular utilization of Michigan State\'s online prescription monitoring records; and (7) employment of an on-site behavioral specialist for patients with mental illness or at risk of drug abuse. Main outcomes and measures: The main endpoint was the percentage of illicit drug use detected per year. Results: A total of 8096 UDS samples were collected over the study period. Mean (SD) participant age was 52 (SD 12) and 51% were male. Urine samples which had at least one illicit substance constituted 41% of the samples in 2014 prior to intervention. We found a significant decrease in the percentage of illicit substances after initiation of the intervention to 37% in 2015, 19% in 2016, and 12% in 2017Q1 (p < 0.001). Conclusion: Adopting a system-wide screening and monitoring measures in a primary care setting can significantly reduce the amount of illicit drug use among patients receiving an opioid prescription for non-cancer pain. This has important implications for patient safety and the current opioid epidemic in the USA. Further studies are needed to evaluate similar interventions in other settings such as a pain clinic.

Limited evidence exists on how non-cancer pain (NCP) affects an individual\'s health-related quality of life (HRQoL). This study aimed to validate the Medical Outcomes Study Short Form-12 Version 2 (SF-12v2), a generic measure of HRQoL, in a NCP cohort using the Medical Expenditure Panel Survey Longitudinal Files. The SF Mental Component Summary (MCS12) and SF Physical Component Summary (PCS12) were tested for reliability (internal consistency and test-retest reliability) and validity (construct: convergent and discriminant; criterion: concurrent and predictive). A total of 15,716 patients with NCP were included in the final analysis. The MCS12 and PCS12 demonstrated high internal consistency (Cronbach\'s alpha and Mosier\'s alpha > 0.8), and moderate and high test-retest reliability, respectively (MCS12 intraclass correlation coefficient (ICC): 0.64; PCS12 ICC: 0.73). Both scales were significantly associated with a number of chronic conditions (p < 0.05). The PCS12 was strongly correlated with perceived health (r = 0.52) but weakly correlated with perceived mental health (r = 0.25). The MCS12 was moderately correlated with perceived mental health (r = 0.42) and perceived health (r = 0.33). Increasing PCS12 and MCS12 scores were significantly associated with lower odds of reporting future physical and cognitive limitations (PCS12: OR = 0.90 95%CI: 0.89-0.90, MCS12: OR = 0.94 95%CI: 0.93-0.94). In summary, the SF-12v2 is a reliable and valid measure of HRQoL for patients with NCP.

OBJECTIVE: Strong opioids are recommended for the treatment of moderate to severe pain. However, some patients do not achieve a successful treatment outcome due to intolerable adverse events and/or inadequate analgesia, thus may benefit from switching to another opioid, a procedure known as \"opioid rotation.\" The type of opioid at treatment initiation may influence the risk of opioid rotation and the objective of this study was to assess such rotation after treatment initiation with two alternative treatments, controlled-release (CR) oxycodone versus CR morphine in patients suffering from non-cancer pain.
METHODS: The study reported here was a real-life study based on Swedish register data: the Prescribed Drug, National Patient, and Cause of Death registers. The captured data cover the entire Swedish population treated in specialist care. A statistical analysis plan was agreed and signed before data were accessed.
RESULTS: Data from 50,223 cases were included in the analyses. The risk of rotation was 19% higher in patients initiating treatment with morphine compared with oxycodone (hazard ratio 1.19; 95% confidence interval 1.11-1.27; P < 0.001), after adjusting for such baseline variables that were both significantly correlated with the outcome variable (time to rotation) and significantly different between the groups; age at index date, osteoarthritis and number of pain-related drugs.
CONCLUSIONS: Patients with non-cancer pain who initiated treatment with CR morphine had a higher risk of opioid rotation than patients initiated with CR oxycodone.