title: What analgesics do older people use prior to initiating oxycodone for non-cancer pain? A retrospective database study.
abstract: BACKGROUND
  Increased oxycodone use has been associated with adverse drug events, non-medical use and overdose deaths.
  
  
  OBJECTIVE
  To explore patterns of non-opioid, weak opioid and strong opioid use prior to initiation of oxycodone for non-cancer pain in a predominantly older Australian population.
  
  
  METHODS
  A retrospective study was conducted using the Australian Government Department of Veterans' Affairs administrative claims database. Analgesic use 12 months prior to incident dispensing of oxycodone was determined for people in the community and in residential aged-care facilities (RACFs). Log-binomial regression was used to compute adjusted rate ratios (RRs) and 95 % confidence intervals (95 % CIs) for the use of other analgesics prior to initiating oxycodone.
  
  
  RESULTS
  Of 10,791 people who initiated oxycodone in 2010, 26 % in community settings and 13 % in RACFs were not dispensed other analgesics in the 12 months prior to initiating oxycodone. Thirty-four percent and 20 % of those in community settings and RACFs, respectively, were not dispensed other analgesics in the previous 4 months. Co-morbidity had little impact on prior analgesic use. Each additional co-morbid condition was associated with a 1.4 % increased likelihood (RR 1.014, 95 % CI 1.012-1.016; p < 0.0001) and a 1.2 % increased likelihood (RR 1.012, 95 % CI 1.009-1.015; p < 0.0001) of being dispensed another analgesic prior to initiating oxycodone in community and RACF settings, respectively.
  
  
  CONCLUSIONS
  Oxycodone is frequently initiated for non-cancer pain without first trialing other analgesics. This highlights the need for prescribing practices to be reviewed in light of increasing concerns about adverse drugs events and death due to oxycodone, particularly in older people.
authors.affiliation: Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.
authors.forename: Svetla
authors.initials: S
authors.lastname: Gadzhanova
authors.forename: J Simon
authors.initials: JS
authors.lastname: Bell
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Roughead
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage* / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010098:Oxycodone / Q000008:administration & dosage* / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy*; D012189:Retrospective Studies
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D010098:Oxycodone