Harms associated with extramedical use of prescription opioid analgesics in Australia: A scoping review

Samanta Lalic, Natali Jokanovic, Jenni Ilomäki, Natasa Gisev, Belinda Lloyd, Dan I. Lubman, J. Simon Bell

Research output: Contribution to journalArticleResearchpeer-review

15 Citations (Scopus)


Background: Evidence is accumulating globally on harms from extramedical prescription opioid analgesic (POA) use. Objective: The aim of this scoping review was to explore harms and documented risk factors associated with extramedical POA use in Australia. Methods: MEDLINE, EMBASE, PsycINFO and CINAHL were searched for original studies published between January 2000 and February 2018. Studies were eligible for inclusion if: 1) POA use was explicitly reported, 2) extramedical use was evident 3) harm was explicitly reported, 4) data were collected in/after 2000, 5) conducted in adults and 6) undertaken in Australia. Results: We identified 560 articles and 16 met the inclusion criteria. Harms reported from extramedical POA use included: increased health service utilization (n = 5), non-fatal overdose (n = 6), fatal overdose (n = 5), injection-related injuries or diseases (n = 4), engagement in crime (n = 2), loss of employment (n = 1), and foreign body pulmonary embolization (n = 1). Multiple drug toxicity was reported as the cause of death in up to 83% of fatal overdose cases. Risk factors for harm included being male, aged 31–49 years, a history of chronic non-cancer pain, mental health disorders and/or substance abuse, and concomitant use of benzodiazepines, antidepressants or other centrally-acting substances. Conclusion: Extramedical use of POAs is associated with a range of harms, including fatal and non-fatal overdose. Polysubstance use with other centrally-acting substances was often implicated. No published studies used linked data sources to provide a comprehensive overview of the extent of POA use or harm in Australia. Future research should focus on undertaking longitudinal cohort studies with linked data sources.

Original languageEnglish
Pages (from-to)925-935
Number of pages11
JournalResearch in Social and Administrative Pharmacy
Issue number8
Publication statusPublished - 2019


  • Australia
  • Drug overdose
  • Extramedical use
  • Harm
  • Opioid analgesics
  • Review

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