Pharmaceutical opioid prescription for chronic pain in Australia: Trajectories of prescribing, risk of adverse events, and predictors of harm (the POINT study)

Chronic non-cancer pain (CNCP) is one of the biggest contributors to disability and is estimated to cost more than cardiovascular disease and cancer. Increased opioid prescribing for CNCP has seen increased opioid overdose and dependence. The trajectories and drivers of long term opioid non-adherence and dependence among CNCP patients are not understood. Short-term trials find only modest pain reduction. Long-term randomised controlled trials (RCTs) are prohibitively expensive and essentially impossible to complete. Novel statistical methods can investigate causal relationships in observational studies, are more feasible than long-term RCTs, and a better research investment. Treatment preferences will be explored to better understand patient behaviour. We will provide novel data on 3, 4 and 5-year outcomes from a cohort of 1,514 CNCP patients prescribed opioids (Pain and Opioids IN Treatment (POINT)). The richness of the data, over seven waves, and unique linkage to healthcare records and data on healthcare costs, will for the first time enable novel statistical methods to answer critical questions about whether, for whom, and which clinical interventions are effective and reduce costs. The work we propose has never been conducted despite calls from international peak bodies and leading researchers. The POINT cohort is assembled and published papers have received international recognition. The timing is crucial given the dearth of information on this important issue.

We will 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?