Opioids in general practice: use or abuse

Context: Pharmaceutical opioid (PO) use has increased four-fold in Australia with increased deaths, mostly by accidental overdose. Pharmaceutical claims showed that 10-20% of the population visited at least four prescribers or three dispensing pharmacies, or obtained at least 20 dispensing. Three (3.1%) percent of the population met all 3 criteria. Doctor-shoppers are believed to have twice the risk of drug-related mortality and opioid-related hospital admissions. Objective: To identify the demographics and drug-seeking behaviour of doctor-shoppers. Design: Identification of patients who have been prescribed at least one opioid between 2000-2017 in the data repository of the UNSW electronic Practice Based Research Network (ePBRN). The prescription strength and dose was used to calculate oral Morphine Equivalent Dose (oMED); visit information to calculate usual provider of care (UPC), Doctor Shopping Quantity (DSQ) and Doctor Shopping Indicator (DSI). Associations with demographic and clinical data of the opioid cohort were examined. Setting: SW Sydney Participants: Fourteen general practices, 200+ GPs and 60,637 active patients. Findings: A cohort of 13, 492 patients (prescribed at least one opioid between 2000-2017) was identified. There was no gender bias. Most were aged 41-70 years, followed by the 21-40 age group. A quarter of the cohort (25%) had mental health co-morbidities. Most opioid users visited only one practice, but often see different providers within the practice. Only a handful visited more than 2 practices. Values for UPC, oMED, DSQ and DSI will be discussed at the conference. Implications for practice: Observational EHR data can be used for timely identification, assessment and monitoring of selected cohorts and, in this case, associations of opioid abuse with cohort characteristics