Introduction: Opioid prescribing to injured workers has increased despite limited evidence supporting the benefits may often outweigh the risks.

Aims: To determine the prevalence and identify predictors of early high-risk and persistent opioid prescribing in injured Australian workers.

Methods: Injured workers with time loss workers’ compensation claim for back and neck conditions who filled at least one opioid prescription within the first 90 days after injury from January 01, 2010 to December 31, 2019 were included. High-risk opioid prescribing practices in the first 90 days were measured using one of four indicators of risk (high-total opioid volume on first dispensing occasion—exceeding 350mg oral morphine equivalent, high average daily dose over 90 days—higher than 50mg oral morphine equivalent, initiation of long-acting opioids, and concurrent psychotropic prescriptions). Persistent opioid use was determined using group-based trajectory modelling over the subsequent 1-year period. Multivariable logistic regression was used to identify predictors of high-risk opioid prescribing and persistent opioid use.

Results: A total of 6,278 injured workers were included. At least one indicator of high-risk opioid prescribing was identified in 67.1% of the sample in the first three months. Persistent opioid use was identified in 24.8% of the sample over the subsequent year. Early high-risk opioid prescribing was associated with double the odds of persistent use (aOR 2.07, CI: 1.80-2.38). Injured workers in inner and outer regional Australia had higher odds of early high-risk prescribing (aOR 1.26, CI: 1.11-1.44) and (aOR 1.43, CI: 1.10-1.87), respectively, compared to those in major cities.

Discussion: Two-thirds of injured workers receiving opioids in the first 90 days showed evidence of high-risk prescribing indicators, with one-quarter exhibiting persistent opioid use over the subsequent year. Early high-risk opioid prescribing doubles the odds of opioid persistence. There is a need for further research and scrutiny of opioid prescribing in this population.

Background: The prevalence of non-opioid substance use has gradually increased worldwide. Benzodiazepines have been frequently used to manage substance withdrawal syndrome due to their sedative and anti-anxiety effects. However, the use of benzodiazepines is associated with a risk of overdose death. To our knowledge, no large nationwide study has focused on death and the receipt of benzodiazepines among patients with non-opioid substance use.

Objectives: To evaluate the association of benzodiazepines and mortality among patients with non-opioid substance use disorder

Methods: We included patients with non-opioid substance use between 2010 to 2019 using Taiwan's NHIRD database and Taiwan Illicit Drug Issue Database. The cohort entry date was defined as the date of the first arrested record during the study period. We classified patients into two treatment strategies of initiating benzodiazepine within one month versus non-benzodiazepine treatment within one month. To emulate the target trial, we applied cloning, censoring, and weighting approach. The primary outcome of interest was all-cause mortality. We estimated the hazard ratio, five-year absolute risks, risk differences and risk ratio with 95% confidence intervals (CIs) with pooled logistic regression.

Results: We included a total of 167,891 patients with non-opioid substance use. The hazard ratio of all-cause mortality was 2.51 (95% CI, 2.29 to 2.84). The five-year absolute risk of all-cause mortality was 6.03% (95% CI, 4.48% to 7.82%) among benzodiazepine users, and 1.48% (95% CI, 1.30% to 1.62%) among non-benzodiazepine users, respectively. The five-year absolute risk difference and risk ratio between the two treatment strategies for all-cause mortality were 4.52% (95% CI, 2.96% to 6.40%) and 4.04 (95% CI, 2.94 to 5.54), respectively.

Conclusion: The use of benzodiazepines is associated with an increased risk of all-cause mortality among patients with non-opioid substance use. Healthcare providers should balance the effectiveness and safety of benzodiazepines for this population.

Aim: Thailand became the first country in Asia to legalize cannabis in 2021, which increased access to medicinal and recreational cannabis. However, our understanding of cannabis use remains limited. This study aimed to examine the prevalence, risk factors, knowledge, and attitude of cannabis use after cannabis legalization in rural communities.
Methods: People aged 18 years and over were surveyed using an online self-questionnaire. Samples were randomly recruited according to the proportion of people in each district in 2023. Descriptive statistics and logistic regression were used to conduct this analysis.
Results: A total of 476 respondents were enrolled. Their mean age was 49.34 (SD=12.08) years. Cannabis users were found to 61 respondents (12.82 %). Total adverse effects after using cannabis are 21.31%. Risk factors associated with cannabis user were male (AORs; 3.49, [95%CI; 1.79 - 6.83], p < 0.001), cancer (AORs; 12.48, [95%CI; 1.87 - 83.04], p = 0.009 ), alcohol consumption(AORs; 2.43, [95%CI; 1.25 - 4.72], p = 0.009), smoking (AORs; 3.11, [95%CI; 1.09 - 8.85], p = 0.033 ), source of cannabis information from friend and family inducement (AORs; 4.25, [95%CI; 2.27 - 7.97], p < 0.001). Most respondents demonstrated an understanding of cannabis regulations, medical cannabis use, and expressed a positive attitude. However, knowledge of recreational use, especially for cooking, seemed lower, indicating a need for more precise information.
Conclusion: The prevalence of cannabis use among rural communities has grown significantly. Five major risk factors associated with cannabis use in rural areas: male gender, cancer, alcohol consumption, smoking, and friend-and-family inducement. This calls for increased awareness and prevention strategies like monitoring use, promoting health education, and creating safe use guidelines for both medical and recreational cannabis. Future research on the causal relationship between factors and adverse consequences is warranted.

Introduction: Psychotropic medicines are frequently prescribed to injured workers. However, data on the extent and determinants of their utilisation in injured Australian workers is limited.

Aims: To characterise the psychotropic medicine utilisation and identify its determinants over three years in workers with back and neck-related conditions following a workers’ compensation claim.

Methods: The utilisation of five groups of psychotropic medicines—antidepressants, gabapentinoids, anxiolytics, hypnotics/sedatives and antipsychotics—in 22,595 workers was examined. The World Health Organisation drug statistics methodology, guidelines for Anatomical Therapeutic Chemical classification and Defined Daily Dose (DDD) assignment were employed. Descriptive statistics were used to characterise the utilisation by time loss duration and temporal trend over the years. Zero-inflated negative binomial regression was employed to identify determinants of psychotropic medicine utilisation.

Results: The overall utilisation (DDD/1000 workers/day) of psychotropics for all-time loss claims was 135.4 (CI: 128.8-142.1). The highest utilisation was for antidepressants (74.2, CI: 70-78.5) followed by gabapentinoids (31.6, CI: 29.7-33.5), anxiolytics (16.1, CI: 14.7-17,6), hypnotics/sedatives (10.6, CI: 9.4-11.8) and antipsychotics (2.9, CI: 2.3-3.4). Claims with increasing time loss duration showed increasing utilisation for each major class of medicine and overall psychotropic utilisation. The incidence rate ratio on the number of DDD for overall psychotropic medicines (1.21, CI: 1.00-1.47), antidepressants (1.29, CI: 1.02-1.63) and antipsychotics (3.47: CI:1.31-9.17) was higher in the age group of 35-44 years. There was a 20.2% increase in dispensing of psychotropic medicines from 2010 to 2016, driven mainly by an increase in gabapentinoid (111.4%) and antidepressant (14.1%) utilisation.

Discussion: The utilisation of psychotropic medicines in compensated Australian workers with time loss claims for back or neck conditions appears to be high, particularly in those with longer time loss durations. There was significant variation in psychotropic medicine utilisation across some sociodemographic-related characteristics. The prescribing trend changed over time, with increasing utilisation of gabapentinoids in recent years

Introduction: The associations between opioid of different potency are unclear, particularly among different dementia subtypes.
Objective: To examine the association between regular opioid (including strong and weak types) use and dementia risk and neuroimaging outcomes, compared with non-opioid use.
Methods: This prospective cohort study was based on UK Biobank participants with non-cancer chronic pain. Regular opioid use was defined as self-reported taken weekly, monthly or three monthly by participants at baseline. Exposures were first categorized in three groups: no analgesics use, non-opioid analgesics (mainly NSAIDs and acetaminophen) use and opioid use. The opioid users were further categorized into strong and weak opioid users. The primary outcome was incident all-cause dementia and its subtypes, including Alzheimer’s disease (AD) and vascular dementia (VD). The secondary outcome was brain magnetic resonance imaging measures.
Results: Among the 197,734 eligible participants, 22,058 (11.2%) reported regular use of opioid.3,997 all-cause dementia, 1,886 AD and 987 VD incident cases were observed over a median of 13.8 years follow-up. Multivariable analyses showed that regular opioid use was associated with increased risk of all-cause dementia (fully adjusted hazard ratio [aHR] 1.14; 95% CI 1.03-1.28), AD (aHR 1.11; 95% CI 0.94-1.32) and VD (aHR 1.38; 95% CI 1.12-1.70), compared with non-analgesics user. In addition, regular strong opioid user had a higher risk of all-cause dementia (aHR 1.54; 95% CI 1.08-2.18) than weak opioid users (aHR 1.13; 95% CI 1.01-1.26). Consistently, regular strong opioid use was associated with an 18611.30 [(95% CI, 4426.21-32796.39] mm3 and 543.66 (95% CI, 299.88-1076.82) mm3 decrease in white matter and hippocampal volumes, while no significant association observed for other neuroimaging outcomes.
Conclusions: Regular use of opioid, especially strong opioid was associated with a higher risk of dementia and lower white matter and hippocampal volume, highlighting the importance of monitoring cognitive function among patients taking strong opioid.

Background: Iron deficiency anemia (IDA) is a global health concern, with ferric carboxymaltose (FCM) emerging as a preferred intravenous therapy for its efficacy and safety profile. Recent reports of FCM-associated mortality necessitate a comprehensive safety evaluation. This study aims to identify potential associations between FCM use and fatal adverse events by analyzing spontaneous reports and conducting an extensive systematic review.
Methods: We conducted a retrospective case/non-case study using spontaneous reports in the FDA Adverse Event Reporting System (FAERS) from FDA approval to September 30, 2023. Disproportionality analysis was conducted by calculating the Proportional Reporting Ratio (PRR), Reporting Odds Ratio (ROR), and Information Component (IC) to identify adverse event signals for FCM (PRR ≥ 2, LB ROR > 1, IC025 > 0). We systematically searched electronic databases, including PubMed, Cochrane CENTRAL, Scopus, and Google Scholar, from inception to December 31, 2023, to support the findings of disproportionality analysis.
Results: 39 death cases were reported in FAERS on FCM. However, no signal of considerable strength was identified [PRR= 0.3 (χ2= 81.4), LB ROR= 0.2, IC025 = -2.4]. We identified significant strength for AEs such as anaphylactic shock [PRR= 5.6 (χ2= 63.5), LB ROR= 3.5, IC025 = 1.5], circulatory collapse [PRR= 15.0 (χ2= 455.5), LB ROR= 10.8, IC025 = 3.1], respiratory distress [PRR= 10.8 (χ2= 338.3), LB ROR= 7.9, IC025= 2.8], arrhythmia [PRR= 3.5 (χ2= 45.2), LB ROR= 2.4, IC025= 1.1]. In the systematic review, we identified the AEs such as anaphylactic reaction, severe hypophosphatemia, respiratory distress, hypotension, bronchospasm, and hypophosphatemia osteomalacia.
Conclusion: Our study identifies potential safety signals associated with FCM, including anaphylactic shock, circulatory collapse, respiratory distress, and arrhythmia. These findings underscore the importance of informed decision-making and careful patient selection when considering FCM therapy, emphasizing the need for heightened vigilance in clinical practice.
Keywords: Ferric carboxymaltose, circulatory collapse, respiratory distress.