Introduction: Opioid analgesic stewardship aims to optimise postoperative opioid prescribing and promote safer opioid use. The impact of the 2022 Australian Opioid Analgesic Stewardship in Acute Pain Clinical Care Standard on surgical opioid prescribing remains unclear. This study evaluated temporal changes in opioid prescribing patterns following stewardship implementation.
Methods: We conducted a retrospective interrupted time-series analysis of surgical patients (2016–2024). Quarterly changes in opioid recipient rates, modified-release opioid prescribing, and oral morphine equivalent (OME) per opioid recipient were assessed before, during, and after stewardship implementation. Models evaluated immediate and sustained changes, adjusted for the COVID-19 period, with subgroup analyses by surgical specialty.
Results: Opioid recipient rates were already declining before stewardship implementation (2.1% reduction per quarter; IRR 0.98, 95% CI 0.97–0.99, p<0.001), with no additional significant post-implementation change. Modified-release opioid prescribing demonstrated a sustained post-implementation decline of 3.3% per quarter (IRR 0.97, 95% CI 0.95–0.98, p<0.001). OME per opioid recipient decreased during the implementation period (−21.7 OME/quarter; 95% CI −39.1 to −4.2) with an immediate reduction following full implementation (−44.3 OME; 95% CI −81.5 to −7.1), although no further sustained decline was observed.
Conclusion: Opioid stewardship was associated with improved prescribing quality, particularly sustained reductions in modified-release opioid use, rather than universal reductions in opioid exposure. The impact of opioid stewardship varied across surgical specialties, highlighting the importance of procedure-specific evaluation to account for differences in postoperative pain severity and analgesic requirements.

Introduction: Pregabalin is commonly used for neuropathic pain; however, its widespread use has been linked to adverse events, dependency, and misuse. Multidisciplinary health services play a crucial role in pain management and may reduce reliance on pharmacotherapy, yet recent trends in pregabalin use in the context of these services remain poorly characterised.
Aims: To investigate longitudinal trends in pregabalin use in Australia, and examine concurrent utilisation of opioids and pain-related health services among pregabalin users.
Methods: This nationwide repeated cross-sectional study (2020-2025) utilised linked Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Schedule (MBS) data. Adults aged ≥18 years with at least one annual PBS or MBS claim were included. Annual prevalence of pregabalin use was calculated. Among users, trends in opioid and health service utilisation were examined, stratified by age, sex, socioeconomic status, remoteness, and region of birth.
Results: An average of 18,880,825 Australians were included annually. Pregabalin prevalence remained stable from 2020 (n= 603,088; 3.3%) to 2025 (n= 607,611; 3.2%), with highest use observed in adults ≥81 years (8.2%). Among users, concurrent opioid use decreased from 59% in 2020 to 53% in 2025. Median annual defined daily dose (DDD) of pregabalin declined from 51 (IQR: 14-168) to 42 (IQR: 14-159). Health service utilisation remained stable, with physical allied health services most commonly used (19%). Notably, demographic groups with higher health service utilisation (females, residents of major cities, Asian-born individuals) were dispensed lower median annual DDDs of both pregabalin and oral morphine equivalents.
Conclusions: While overall pregabalin prevalence remained stable, concurrent opioid use and dosages declined. Higher engagement with allied health services was associated with lower pharmacotherapy burden, suggesting a potential role for multidisciplinary care in optimising pain management. Furthermore, complex cultural and access-related factors likely play a critical role in shaping these prescribing patterns.
Keywords: Pregabalin, Health service, Pain

Introduction. Gabapentin is increasingly used as an alternative to opioids. However, concurrent gabapentin-opioids use remains common despite FDA warnings regarding potential safety risks, highlighting the need for interventions to reduce potentially inappropriate co-prescribing.

Aims. To evaluate whether concurrent gabapentin-opioids prescribing patterns change following receipt of a comprehensive medication review (CMR) among Medicare beneficiaries enrolled in the Medication Therapy Management (MTM) program.

Methods. We conducted a retrospective cohort study of Medicare beneficiaries enrolled in the MTM program who initiated gabapentin while concurrently using opioids. Beneficiaries who received a CMR after gabapentin initiation were classified as CMR-exposed, with the CMR date defined as the index. Using exposure density sampling, beneficiaries who did not receive a CMR were matched 1:2 on days from cohort entry to index and classified as CMR-unexposed. Both groups were required to be concurrent gabapentin-opioid users at index, allowing a 7-day grace period between prescription fills. Outcomes included discontinuation of concurrent gabapentin-opioid use (defined as ≥30 days without overlap) and naloxone prescribing during the 6 month or one year follow up.

Results. Among eligible beneficiaries, 781 CMR-exposed (mean [SD] age: 76.8 [6.3]; 65.9% female) and 1,562 CMR-unexposed (77.1 [6.6]; 63.3%) concurrent gabapentin-opioid users were identified. During 6 months of follow-up, 62.9% of CMR-exposed and 58.2% of CMR-unexposed beneficiaries discontinued concurrent gabapentin-opioid use. During 12-month follow up, 72.5% of CMR-exposed and 67.0% of CMR-unexposed beneficiaries discontinued concurrent gabapentin-opioid use. Naloxone prescribing was higher in the CMR-exposed (2.6%) than the CMR-unexposed beneficiaries (0.8%).

Conclusions. Beneficiaries who received a CMR were more likely to discontinue concurrent gabapentin-opioid use and receive naloxone than those who did not. CMRs may represent an opportunity to improve medication safety among concurrent users, although further research is needed to evaluate the impact on gabapentin-opioid prescribing.

Keywords: gabapentin, opioid, comprehensive medication review

Introduction: In response to rising opioid-related harms, Australia has implemented several policies to reduce opioid prescribing. However, existing surveillance often aggregates opioid poisonings, limiting assessment of trends by opioid type and potential shifts between pharmaceutical and illicit opioids.

Aims: To leverage structure and unstructured data to examine and compare temporal trends in opioid poisoning presentations to emergency departments and identify and quantify significant structural changes over time.

Methods: We analysed ED presentations recorded in the Victorian Emergency Minimum Dataset (VEMD), managed by the Victorian Injury Surveillance Unit (VISU) between July 2009 and June 2024. Opioid poisoning presentations were identified and classified by opioid type using a rule-based algorithm that combined ICD-10 diagnostic codes and free-text clinical descriptions. Age-standardised presentation rates for heroin-, codeine-, oxycodone-, and other controlled opioid-related poisonings were modelled using sex-stratified generalised additive models, and first-derivative analyses were used to identify periods of statistically significant change.

Results: A total of 15,678 opioid poisoning presentations were identified, of which 7,049 (45.0%) involved illicit opioids. Heroin-related presentations among females remained stable throughout the study period. In contrast, heroin-related poisoning among males declined significantly between February and December 2020 (monthly change: -0.50 per 100,000 population; 95% CI: -0.92 to -0.24), followed by a brief increase between August and October 2021 (0.50 per 100,000 per month; 95% CI: 0.01–0.70). Codeine-related poisoning presentations declined significantly between 2016 and 2018 among both males and females, with rates remaining stable thereafter. Oxycodone-related poisonings showed a brief increase during 2012 but remained otherwise stable over the 15-year period. No trend changes were observed for controlled prescription opioids.

Conclusions: Pharmaceutical and illicit opioid poisonings showed different temporal patterns over the study period. Enhanced surveillance using both coded and free-text clinical information provides a more comprehensive understanding of opioid-related harms and can support more targeted public health responses.

Introduction: Cold weather and sedative use are both risk factors for hip fracture in older adults. However, potential interactions between them have not been investigated.

Aims: To investigate whether sedative medication use modifies associations between ambient temperature and hip fracture risk.

Methods: We conducted a time-stratified case-crossover study of people aged ≥50 years hospitalised for first hip fracture in Victoria, Australia, between 2013/07/01-2018/06/30. Gridded daily meteorological data from Scientific Information for Land Owners (SILO) were linked to residential postcodes to capture mean ambient temperature exposure. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for temperature percentile categories (≤1st, 2nd-5th, 6th-15th, 16th-25th, >75th) referenced against the 26th-75th percentile. Effect modification by sedative use (ATC:N05B/N05C) in 60 days before hospitalisation was assessed using an interaction term. ORs were adjusted for public holidays and healthcare utilisation in preceding six days. Subgroup analyses were conducted for age, sex, and hospital frailty risk score (HFRS).

Results: We identified 28,904 people hospitalized for hip fracture, of which 4,854 (16.8%) were dispensed a sedative prior to hospitalisation, 19,779 (68.4%) were female, 18,611 (64.39%) were aged ≥80 years, and 11,191 (38.7%) had HFRS > 5. In non-sedative users, temperature exposure was not significantly associated with hip fracture (≤1st: adjusted OR 1.09[CI 0.90–1.31]; 2nd-5th: 0.95[0.86–1.04]; 6th-15th: 1.01[0.94–1.08]; 16th-25th: 1.01[0.95–1.07]; >75th: 0.96[0.91–1.01]). Among sedative users, elevated odds of hip fracture were associated with lower temperatures (≤1st: 2.09[1.33–3.30]; 2nd-5th: 1.36[1.08–1.73]), but not higher temperatures (6th-15th: 1.16[0.98–1.36]; 16th-25th:1.02[0.87–1.19]; >75th: 0.94[0.84–1.06]). Within sedative users, lower temperatures were significant for both age and sex subgroups, and only significant for the higher HFRS subgroup.

Conclusions: Lower temperatures were associated with increased hip fracture risk in sedative users with higher frailty risk, suggesting increased vulnerability to environmental conditions in this population.

Keywords: Environmental pharmacoepidemiology, hip fracture, sedative

Introduction: Use of opioids and gabapentinoids is increasing, despite high risk of medication-related harms. Concurrent use with other central nervous system depressants, including benzodiazepines and anti-depressants, further increases the risk of medication-related harms and poor outcomes, especially for the older population.

Aims: To examine the prevalence of opioid or gabapentinoid use concurrently with benzodiazepines or anti-depressants in the older population and to quantify the risk of mortality or entry to a long-term care facility(LTCF).

Methods: A retrospective cohort study was conducted using the Registry of Senior Australians National Historical Cohort of all individuals aged ≥65 years between 2017-2020 receiving home care. Concurrent use of opioids or gabapentinoids with benzodiazepines or anti-depressants were compared to opioid or gabapentinoid use alone, using an intention-to-treat design. Individuals were followed from first dispensing of single or concurrent medication episode. Adjusted Cox regression models estimated HRs(95%CI) for mortality and adjusted subdistribution hazard ratios(aSHRs) for LTCF entry using Fine-Gray models.

Results: 121,333 individuals were included (median age 82years, 66% female and median 6 chronic conditions). Prevalence of opioid use alone was 30.9%, with 20.5% using a benzodiazepine and 37.1% anti-depressant concurrently. There was a higher risk of entry to a LTCF with concurrent benzodiazepine (6% increased risk: aSHR=1.06,95%CI 1.03-1.10) or anti-depressant (17%: aSHR=1.17,95%CI 1.14-1.21) use compared to opioids alone. Prevalence of gabapentinoid use alone was 7.8% and 7.3% had concurrent benzodiazepine and 16.4% concurrent anti-depressant use. Compared to gabapentinoids alone, there was 19% and 39% higher risk of LTCF entry with concurrent benzodiazepine (aSHR=1.19,95%CI 1.08-1.31) or anti-depressant (sHR=1.39,95%CI 1.26-1.52) use.

Conclusions: Concurrent use of opioids or gabapentinoids with benzodiazepines or anti-depressants are associated with increased risks of adverse outcomes in the older population. Medication reviews and targeted deprescribing of these commonly used medications are needed to mitigate medication-related harms.

Keywords: inappropriate co-prescribing, adverse outcomes, older population