Lalic S, et al. - Researchers conducted a retrospective cohort study examining the rate and predictors of transitioning to high-dose or strong opioids among people initiating opioids. From a random 10% sample of Australia's Pharmaceutical Benefits Scheme eligible population, they identified people initiating opioid analgesics from July 2013 to January 2018. In total, they identified 861,691 people who received opioids at average doses < 50mg Oral Morphine Equivalents (OMEs)/day (Cohort 1), 874,401 people who received opioids at average doses < 90mg OMEs/day (Cohort 2) and 603,884 people who initiated weak opioids (Cohort 3). Escalation to doses ≥ 50mg OMEs/day was observed in 1.4% of people, to doses ≥ 90mg OMEs/day was observed in 0.8% of people, and there were 7.3% who transitioned to strong opioids. Observations revealed transitioning of more than one in every 13 people initiating weak opioids to strong opioids in Australia. By extrapolation, escalation to high doses occurs in more than 26,000 Australian adults initiating opioids each year. Transition to strong and high-dose opioids was more rapid among people with cancer treatment history, older people and males.