Bianca Blanch

An overview of the patterns of prescription opioid use, costs and related harms in Australia

AIMS To report Australian population trends in subsidized prescribed opioid use, total costs to the Australian government to subsidize these medicines and opioid-related harms based on hospitalizations and accidental poisoning deaths. METHODS We utilized three national aggregated data sources including dispensing claims from the Pharmaceutical Benefits Scheme, opioid-related hospitalizations from the National Hospital Morbidity Database and accidental poisoning deaths from the Australian Bureau of Statistics. RESULTS Between 1992 and 2012, opioid dispensing episodes increased 15-fold (500 000 to 7.5 million) and the corresponding cost to the Australian government increased 32-fold (

Retrospective studies of end-of-life resource utilization and costs in cancer care using health administrative data: a systematic review.

8.5 million to

Twenty-five years of prescription opioid use in Australia: a whole-of-population analysis using pharmaceutical claims.

271 million). Opioid-related harms also increased. Opioid-related hospitalizations increased from 605 to 1464 cases (1998-2009), outnumbering hospitalizations due to heroin poisonings since 2001. Deaths due to accidental poisoning (pharmaceutical opioids and illicit substances combined) increased from 151 to 266 (2002-2011), resulting in a rise in the death rate of 0.78 to 1.19 deaths/100 000 population over 10 years. Death rates increased 1.8 fold in males and 1.4 fold in females. CONCLUSIONS The striking increase in opioid use and related harms in Australia is consistent with trends observed in other jurisdictions. Further, there is no evidence to suggest these increases are plateauing. There is currently limited evidence in Australia about individual patterns of opioid use and the associated risk of adverse events. Further research should focus on these important issues so as to provide important evidence supporting effective change in policy and practice.

Does gender influence response to differing psychotherapies by those with unipolar depression

Background: There has been an increase in observational studies using health administrative data to examine the nature, quality, and costs of care at life’s end, particularly in cancer care. Aim: To synthesize retrospective observational studies on resource utilization and/or costs at the end of life in cancer patients. We also examine the methods and outcomes of studies assessing the quality of end-of-life care. Design: A systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (A Measurement Tool to Assess Systematic Reviews) methodology. Data sources: We searched MEDLINE, Embase, CINAHL, and York Centre for Research and Dissemination (1990–2011). Independent reviewers screened abstracts of 14,424 articles, and 835 full-text manuscripts were further reviewed. Inclusion criteria were English-language; at least one resource utilization or cost outcome in adult cancer decedents with solid tumors; outcomes derived from health administrative data; and an exclusive end-of-life focus. Results: We reviewed 78 studies examining end-of-life care in over 3.7 million cancer decedents; 33 were published since 2008. We observed exponential increases in service use and costs as death approached; hospital services being the main cost driver. Palliative services were relatively underutilized and associated with lower expenditures than hospital-based care. The 15 studies using quality indicators demonstrated that up to 38% of patients receive chemotherapy or life-sustaining treatments in the last month of life and up to 66% do not receive hospice/palliative services. Conclusion: Observational studies using health administrative data have the potential to drive evidence-based palliative care practice and policy. Further development of quality care markers will enhance benchmarking activities across health care jurisdictions, providers, and patient populations.

The superiority of antidepressant medication to cognitive behavior therapy in melancholic depressed patients: a 12-week single-blind randomized study

AIM The aim of this paper is to investigate 25-year trends in community use of prescribed opioid analgesics in Australia, and to map these trends against major changes to opioid registration and subsidy. METHODS We obtained dispensing data from 1990 to 2014 from two sources: dispensing claims processed under Australias national drug subsidy programme, the Pharmaceutical Benefits Scheme, including under co-payment records from 2012; and estimates of non-subsidized medicine use from a survey of Australian pharmacies (until 2011). Utilization was expressed in defined daily doses (DDD)/1000 population/day. RESULTS Opioid dispensing increased almost four-fold between 1990 and 2014, from 4.6 to 17.4 DDD/1000 pop/day. In 1990, weak, short-acting or orally administered opioids accounted for over 90% of utilization. Use of long-acting opioids increased over 17-fold between 1990 and 2000, due primarily to the subsidy of long-acting morphine and increased use of methadone for pain management. Between 2000 and 2011, oxycodone, fentanyl, buprenorphine, tramadol and hydromorphone use increased markedly. Use of strong opioids, long-acting and transdermal preparations also increased, largely following the subsidy of various opioids for noncancer pain. In 2011, the most dispensed opioids were codeine (41.1% of total opioid use), oxycodone (19.7%) and tramadol (16.1%); long-acting formulations comprised approximately half, and strong opioids 40%, of opioid dispensing. CONCLUSIONS Opioid utilization in Australia is increasing, although these figures remain below levels reported in the US and Canada. The increased use of opioids was largely driven by the subsidy of long-acting formulations and opioids for the treatment of noncancer pain.

Trends in opioid utilisation in Australia, 2006-2015: insights from multiple metrics

BACKGROUND There have been few studies that have specifically examined for any impact of gender on response to psychotherapy for those with depression. We therefore undertook a review and report findings. METHOD A literature review was conducted by first seeking to identify studies via relevant search engines and then examining a number of secondary sources. RESULTS There was no clear or consistent evidence to suggest that gender has any impact on response to psychotherapy. CONCLUSIONS The review identified relatively few studies, so limiting our capacity to draw more than provisional conclusions. As some studies of response to antidepressant drugs have suggested differential gender response, such gender differences may then be expected to reflect biological influences rather than any general tendency for gender to influence response to therapy non-specifically.

The ‘real world’ utility of a web‐based bipolar disorder screening measure

To pursue the previously long‐standing but formally untested clinical view that melancholia is preferentially responsive to antidepressant medication in comparison with psychotherapy [specifically Cognitive Behavior Therapy (CBT)]. Second, to determine whether a broader action antidepressant medication sequencing regimen is superior to a Selective Serotonin Reuptake Inhibitor (SSRI) alone.

Looking forward and looking back: the balancing act in new drug user designs for pharmacoepidemiological research†

Population‐based observational studies have documented global increases in opioid analgesic use. Many studies have used a single population‐adjusted metric (number of dispensings, defined daily doses [DDDs], or oral morphine equivalents [OMEs]). We combine these volume‐based metrics with a measure of the number of persons dispensed opioids to gain insights into Australian trends in prescribed opioid use.

The POPPY Research Programme protocol: investigating opioid utilisation, costs and patterns of extramedical use in Australia

To determine whether those completing a self‐report bipolar self‐test measure and identified as having a likely bipolar disorder judged the self‐test as useful and had a subsequent superior illness course.

Is cognitive behaviour therapy of benefit for melancholic depression

It has long been known that the length of a look-back period to determine new versus previous users of a specific medication can introduce misclassification and bias study findings. In a large cohort of Danish children dispensed asthma medications and antibiotics, Riis et al. recently showed that new-user designs using look-back periods of 2years can introduce severe misclassification.1 We are currently undertaking a programme of research in Australia examining the use and outcomes associated with prescription antipsychotic and opioid medications. We have been developing our study methodology based on different look-back periods. To add further evidence to the Riis et al. study, we detail our experience in quantifying the effect of 10 look-back periods on the misclassification of newusers of antipsychotics and opioid analgesics (with and without codeine preparations) in Australian adults. Australia has a publicly funded universal healthcare system entitling all citizens and permanent residents to a range of subsidised health services including prescription medication via the Pharmaceutical Benefits Scheme (PBS). The Department of Human Services (DHS) established a standardised dataset of PBS dispensing claims for a random 10% sample of Australians in March 2005. We have a contract with DHS for use of this data for pharmacoepidemiological research with quarterly data updates. A record is created in this dataset when an individual receives government subsidy for any PBS-listed medication. An individual is eligible for subsidy when the medication is priced above the patient co-payment amount. Australia has a two-tiered co-payment system meaning that low-cost PBS medications dispensed to individuals with the highest co-payment (general beneficiaries) are not captured in this dataset. However, all medications are priced above the concessional beneficiary co-payment meaning complete ascertainment of PBS-listed medication in this patient group. We focus our analyses on the latter group. The medication classes of interest were antipsychotics (ATC code: N05A) and opioid analgesics (ATC codes: N02A, R05DA04, N07BC [methadone for the indication of pain alone]). Our study population included persons aged ≥18years at 1 January 2005 who were concessional beneficiaries for the entire period between 1 July 2005 and 30 June 2014. For each medication class of interest, we categorised persons as true new users (dispensing between 1 July 2012 and 30 June 2014 and no dispensings between 1 July 2005 and 30 June 2012) or true prior users (dispensing between 1 July 2012 and 30 June 2014 and a dispensing between 1 July 2005 and 30 June 2012). This project was approved by the Population and Health Services Research Ethics Committee (2013/11/ 494) and DHS (MI2593; MI2779). We calculated the relative misclassification (RM) based on 10 look-back periods: 1, 3, and 6months and annual look-back periods from 1 to 7years, defined as the time period prior to each individual’s index dispensing. We calculated the RM of new users by dividing the number of defined new users (dispensing between 1 July 2012 and 30 June 2014 and no dispensings during the look-back period of interest) by the number of true new users. We calculated RM and 95% confidence intervals (using bootstrap methods) for each look-back period. We identified 24375 antipsychotic users between 1 July 2012 to 30 June 2014. RM decreased from 2.51 at 1month to 1.01 at 7years. We identified 132153 opioid users including codeine preparations and 80333 opioid users excluding codeine preparations. RM decreased from 3.61 at 1month to 1.08 at 7years and 2.23 at 1month to 1.04 at 7years, respectively (Table 1). Consistent with the findings of Riis et al., our study shows that varying look-back periods impact on the RM of new users1 and that RM is higher for medication used intermittently (opioids are likely to be used intermittently). Opioid users excluding †Prior postings/presentations: this work has never previously been reported or presented.