Lalic S, et al. - Given the association of strong and high-dose opioids with opioid overdose and death, researchers investigated 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 assessed people initiating opioid analgesics from July 2013 to January 2018 in this retrospective cohort study. They identified in total 861,691 people who began opioids at average doses < 50 mg oral morphine equivalents (OMEs)/day, 874,401 initiated at < 90 mg OMEs/day and 603,884 initiated weak opioids. Overall, 1.4% of people escalated to doses ≥ 50 mg OMEs/day, 0.8% to doses ≥ 90 mg OMEs/day and 7.3% transitioned to strong opioids. Observations revealed that more than one in every 13 people initiating weak opioids transition to strong opioids in Australia. Each year, more than 26,000 Australian adults initiating opioids escalate to high doses. Transition to strong and high-dose opioids was more rapidly noted among people with cancer treatment history, older people and males than others.