Children in Social Research: Do Higher Payments Encourage Participation in Riskier Studies?

The MESSI (Managing Ethical Studies on Sensitive Issues) study used hypothetical scenarios, presented via a brief online survey, to explore whether payment amounts influenced Australian children and young people to participate in social research of different sensitivity. They were more likely to participate in the lower sensitivity study than in the higher at all payment levels (A$200 prize draw, no payment, $30, or $100). Offering payments to children and young people increased the likelihood that they would agree to participate in the studies and, in general, the higher the payments, the higher the likelihood of their participating. No evidence of undue influence was detected: payments can be used to increase the participation of children and young people in research without concerns of undue influence on their behavior in the face of relatively risky research. When considering the level of payment, however, the overriding consideration should be the level of risk to the children and young people.

A synthesis of oral morphine equivalents (OME) for opioid utilisation studies.

PURPOSE: Oral Morphine Equivalent (OME) doses are increasingly being used as a metric to represent opioid use. Driven by a growing need from pharmacoepidemiological studies, the objective of this study was to develop a comprehensive OME conversion table that can be used by researchers to calculate OMEs in a consistent and systematic way. METHODS: Clinical guidelines and literature sources were collated and synthesised to develop recommended OME conversion factors that can be used for research studies on opioids (including different formulations and routes of administration) currently available internationally including Australia, the United Kingdom, Europe, the United States and Canada. RESULTS: No single resource includes all opioids that are currently available. Although there was some variation in conversion factors reported in different sources, overall, suggested conversion factors were mostly consistent across national and international sources. CONCLUSIONS: The use of the OME metric appears optimal for opioid utilisation studies as it facilities both interpretation and comparison between opioids and geographical locations. We have presented a synthesis of published OME conversion factors that can be applied to pharmacoepidemiological studies of opioids, in addition to a discussion of the considerations and caveats in using OME as a metric for opioid use. Copyright © 2015 John Wiley & Sons, Ltd.

Benzodiazepine use among chronic pain patients prescribed opioids: associations with pain, physical and mental health, and health service utilization.

OBJECTIVE: Benzodiazepines (BZDs) are commonly used by chronic pain patients, despite limited evidence of any long-term benefits and concerns regarding adverse events and drug interactions, particularly in older patients. This article aims to: describe patterns of BZDs use; the demographic, physical, and mental health correlates of BZD use; and examine if negative health outcomes are associated with BZD use after controlling for confounders. SUBJECTS: A national sample of 1,220 chronic noncancer pain (CNCP) patients prescribed long-term opioids. METHODS: We report on baseline data from a prospective cohort study comparing four groups based on their current BZD use patterns. General demographics, pain, mental and physical comorbidity, and health service utilization were examined. RESULTS: One-third (N = 398, 33%) of participants reported BZD use in the past month, and 17% (N = 212) reported daily BZD use. BZD use was associated with: 1) greater pain severity, pain interference with life, and lower feelings of self-efficacy with respect to their pain; 2) being prescribed "higher-risk" (>200 mg oral morphine equivalent) doses of opioids; 3) using antidepressant and/or antipsychotic medications; 4) substance use (including more illicit and injection drug use, alcohol use disorder, and daily nicotine use); and 5) greater mental health comorbidity. After controlling for differences in demographic characteristics, physical and mental health, substance use, and opioid dose, BZD use was independently associated with greater past-month use of emergency health care such as ambulance or accident and emergency services. CONCLUSIONS: CNCP patients using BZDs daily represent a high-risk group with multiple comorbid mental health conditions and higher rates of emergency health care use. The high prevalence of BZD use is inconsistent with guidelines for the management of CNCP or chronic mental health conditions.

Cohort protocol paper: the Pain and Opioids In Treatment (POINT) study.

BACKGROUND: Internationally, there is concern about the increased prescribing of pharmaceutical opioids for chronic non-cancer pain (CNCP). In part, this is related to limited knowledge about the long-term benefits and outcomes of opioid use for CNCP. There has also been increased injection of some pharmaceutical opioids by people who inject drugs, and for some patients, the development of problematic and/or dependent use. To date, much of the research on the use of pharmaceutical opioids among people with CNCP, have been clinical trials that have excluded patients with complex needs, and have been of limited duration (i.e. fewer than 12 weeks). The Pain and Opioids In Treatment (POINT) study is unique study that aims to: 1) examine patterns of opioid use in a cohort of patients prescribed opioids for CNCP; 2) examine demographic and clinical predictors of adverse events, including opioid abuse or dependence, medication diversion, other drug use, and overdose; and 3) identify factors predicting poor pain relief and other outcomes. METHODS/DESIGN: The POINT cohort comprises around 1,500 people across Australia prescribed pharmaceutical opioids for CNCP. Participants will be followed-up at four time points over a two year period. POINT will collect information on demographics, physical and medication use history, pain, mental health, drug and alcohol use, non-adherence, medication diversion, sleep, and quality of life. Data linkage will provide information on medications and services from Medicare (Australia's national health care scheme). Data on those who receive opioid substitution therapy, and on mortality, will be linked. DISCUSSION: This study will rigorously examine prescription opioid use among CNCP patients, and examine its relationship to important health outcomes. The extent to which opioids for chronic pain is associated with pain reduction, quality of life, mental and physical health, aberrant medication behavior and substance use disorders will be extensively examined. Improved understanding of the longer-term outcomes of chronic opioid therapy will direct community-based interventions and health policy in Australia and internationally. The results of this study will assist clinicians to better identify those patients who are at risk of adverse outcomes and who therefore require alternative treatment strategies.

Diversion of prescribed opioids by people living with chronic pain: results from an Australian community sample.

INTRODUCTION AND AIMS: There has been an increase in prescription of opioids for chronic non-cancer pain, and concern exists over possible diversion of prescription opioids to the illicit marketplace. Recent media coverage suggests that elderly patients sell their prescribed opioids for additional income. This study investigated the extent to which an Australian community sample of chronic pain patients prescribed opioids reported supplying their prescribed opioids to others. DESIGN AND METHODS: Participants living with chronic non-cancer pain and prescribed opioids for their pain (n=952) were recruited across Australia via advertisements at pharmacies. A telephone interview included questions about their pain condition and opioid medication. RESULTS: Participants had been living with pain for a mean of 14.2 years; most common conditions included chronic back/neck problems and arthritis/rheumatism. Around half (43%) were currently prescribed one opioid, and 55% had been prescribed 2-5 opioids; the most common was oxycodone. Forty-two participants (4%) reported ever supplying prescribed opioids to another person; one participant reported receiving payment. Participants who supplied opioids to others were younger (odds ratio 0.97, 95% confidence interval 0.95-0.99) and engaged in a greater number of aberrant behaviours relating to their opioid medication (odds ratio 1.77, 95% confidence interval 1.45-2.17), including tampering with doses, taking opioids by alternative routes, seeing doctors to obtain extra opioids and refilling prescriptions early. DISCUSSION AND CONCLUSION: Few people with chronic non-cancer pain divert their opioids to others. Media reports of elderly patients selling their opioids to supplement their income may be reflective of exceptional cases. Future studies may investigate the extent to which other patient groups divert prescription opioids to the illicit marketplace.