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Jani M, Girard N, Bates DW, Buckeridge DL, Sheppard T, Li J, Iqbal U, Vik S, Weaver C, Seidel J, Dixon WG, Tamblyn R. Opioid prescribing among new users for non-cancer pain in the USA, Canada, UK, and Taiwan: A population-based cohort study. PLoS Med 2021; 18:e1003829. [PMID: 34723956 PMCID: PMC8601614 DOI: 10.1371/journal.pmed.1003829] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 11/18/2021] [Accepted: 09/30/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The opioid epidemic in North America has been driven by an increase in the use and potency of prescription opioids, with ensuing excessive opioid-related deaths. Internationally, there are lower rates of opioid-related mortality, possibly because of differences in prescribing and health system policies. Our aim was to compare opioid prescribing rates in patients without cancer, across 5 centers in 4 countries. In addition, we evaluated differences in the type, strength, and starting dose of medication and whether these characteristics changed over time. METHODS AND FINDINGS We conducted a retrospective multicenter cohort study of adults who are new users of opioids without prior cancer. Electronic health records and administrative health records from Boston (United States), Quebec and Alberta (Canada), United Kingdom, and Taiwan were used to identify patients between 2006 and 2015. Standard dosages in morphine milligram equivalents (MMEs) were calculated according to The Centers for Disease Control and Prevention. Age- and sex-standardized opioid prescribing rates were calculated for each jurisdiction. Of the 2,542,890 patients included, 44,690 were from Boston (US), 1,420,136 Alberta, 26,871 Quebec (Canada), 1,012,939 UK, and 38,254 Taiwan. The highest standardized opioid prescribing rates in 2014 were observed in Alberta at 66/1,000 persons compared to 52, 51, and 18/1,000 in the UK, US, and Quebec, respectively. The median MME/day (IQR) at initiation was highest in Boston at 38 (20 to 45); followed by Quebec, 27 (18 to 43); Alberta, 23 (9 to 38); UK, 12 (7 to 20); and Taiwan, 8 (4 to 11). Oxycodone was the first prescribed opioid in 65% of patients in the US cohort compared to 14% in Quebec, 4% in Alberta, 0.1% in the UK, and none in Taiwan. One of the limitations was that data were not available from all centers for the entirety of the 10-year period. CONCLUSIONS In this study, we observed substantial differences in opioid prescribing practices for non-cancer pain between jurisdictions. The preference to start patients on higher MME/day and more potent opioids in North America may be a contributing cause to the opioid epidemic.
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Affiliation(s)
- Meghna Jani
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, United Kingdom
- Department of Rheumatology, Salford Royal Foundation Trust, Salford, United Kingdom
| | - Nadyne Girard
- Department of Epidemiology, Biostatistics & Occupational Health, University of McGill, Montreal, Canada
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada
| | - David W. Bates
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - David L. Buckeridge
- Department of Epidemiology, Biostatistics & Occupational Health, University of McGill, Montreal, Canada
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada
| | - Therese Sheppard
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, United Kingdom
| | - Jack Li
- International Centre for Health Information Technology (ICHIT), Taipei Medical University, Taipei City, Taiwan
- Graduate Institute of Biomedical Informatics, College of Medicine Science and Technology, Taipei Medical University, Taipei City, Taiwan
| | - Usman Iqbal
- International Centre for Health Information Technology (ICHIT), Taipei Medical University, Taipei City, Taiwan
- Graduate Institute of Biomedical Informatics, College of Medicine Science and Technology, Taipei Medical University, Taipei City, Taiwan
| | - Shelly Vik
- Applied Research and Evaluation Services, Alberta Health Services, Calgary, Canada
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Colin Weaver
- Applied Research and Evaluation Services, Alberta Health Services, Calgary, Canada
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Judy Seidel
- Applied Research and Evaluation Services, Alberta Health Services, Calgary, Canada
- Department of Community Health Science, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - William G. Dixon
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, United Kingdom
- Department of Rheumatology, Salford Royal Foundation Trust, Salford, United Kingdom
| | - Robyn Tamblyn
- Department of Epidemiology, Biostatistics & Occupational Health, University of McGill, Montreal, Canada
- Clinical and Health Informatics Research Group, McGill University, Montreal, Canada
- * E-mail:
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Hua X, Chen LM, Zhu Q, Hu W, Lin C, Long ZQ, Wen W, Sun XQ, Lu ZJ, Chen QY, Luo DH, Sun R, Mo HY, Tang LQ, Zhang WW, He ZY, Mai HQ, Lin HX, Guo L. Efficacy of controlled-release oxycodone for reducing pain due to oral mucositis in nasopharyngeal carcinoma patients treated with concurrent chemoradiotherapy: a prospective clinical trial. Support Care Cancer 2019; 27:3759-3767. [PMID: 30712098 PMCID: PMC6726700 DOI: 10.1007/s00520-019-4643-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 01/14/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Pain due to oral mucositis (OM) is a major problem during concurrent chemoradiotherapy (CCRT) in nasopharyngeal carcinoma (NPC) patients. METHODS We enrolled 56 NPC patients receiving CCRT and allocated them into two groups: moderate pain group (n = 27) and a severe pain group (n = 29) according to the degree of pain reported (moderate = numerical rating scale (NRS) score 4-6 or severe = NRS score 7-10) at initiation of controlled-release oxycodone (CRO) treatment. RESULTS Total dose of CRO was significantly higher in severe pain patients than in moderate pain patients (791.60 ± 332.449 mg vs. 587.27 ± 194.940 mg; P = 0.015). Moderate pain patients had significantly better quality of life (P = 0.037), lower weight loss (P = 0.030) and more active CCRT response (90.9% vs. 64.0%; P = 0.041). Although 24-h pain control rate was comparable in the two groups (85.2% vs. 86.2%; P = 0.508), the moderate pain group score eventually stabilized at ~ 2 vs. 3 in the severe pain group (P < 0.001); the titration time to reach bearable pain (NRS ≤ 3) was also significantly shorter in moderate pain patients (2.45 ± 0.60 days vs. 3.60 ± 1.98 days; P = 0.012). Incidence of adverse events was comparable in both groups. CONCLUSIONS The study findings suggest that early introduction of low-dose CRO at the moderate pain stage could help reduce the total dose required, provide better pain control, improve quality of life, and enhance CCRT response.
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Affiliation(s)
- Xin Hua
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou, 510060, China
- Department of Radiotherapy, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lin-Min Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou, 510060, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Qian Zhu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou, 510060, China
| | - Wen Hu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou, 510060, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chao Lin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou, 510060, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhi-Qing Long
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou, 510060, China
- Department of Radiotherapy, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wen Wen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou, 510060, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiao-Qing Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou, 510060, China
- Department of Radiotherapy, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zi-Jian Lu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou, 510060, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Qiu-Yan Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou, 510060, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Dong-Hua Luo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou, 510060, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Rui Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou, 510060, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hao-Yuan Mo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou, 510060, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lin-Quan Tang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou, 510060, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wen-Wen Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou, 510060, China
- Department of Radiotherapy, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhen-Yu He
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou, 510060, China
- Department of Radiotherapy, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Hai-Qiang Mai
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou, 510060, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Huan-Xin Lin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou, 510060, China.
- Department of Radiotherapy, Sun Yat-sen University Cancer Center, Guangzhou, China.
| | - Ling Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou, 510060, China.
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China.
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Gomes T, Jain S, Paterson JM, Sketris I, Caetano P, Henry D. Trends and uptake of new formulations of controlled-release oxycodone in Canada. Pharmacoepidemiol Drug Saf 2018; 27:520-525. [PMID: 29359446 PMCID: PMC5947657 DOI: 10.1002/pds.4390] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 12/15/2017] [Accepted: 12/19/2017] [Indexed: 01/11/2023]
Abstract
Purpose This study investigated the impact of changing availability of tamper‐deterrent and non‐tamper‐deterrent oxycodone on prescribing patterns of controlled‐release oxycodone across Canada. Methods We conducted a population‐based, serial cross‐sectional study of controlled‐release oxycodone dispensing from community pharmacies across Canada between October 2007 and April 2016. We calculated rates of dispensing (tablets per 100 population) and reported the relative market share of generic non‐tamper‐deterrent controlled‐release oxycodone. All analyses were reported nationally and stratified by province. Results After the introduction of a tamper‐deterrent formulation, the national rate of controlled‐release oxycodone dispensing fell by 44.6% (from 26.4 to 14.6 tablets per 100 population from February 2012 to April 2016). Between December 2012 and July 2013, there was moderate uptake of generic non‐tamper‐deterrent controlled‐release oxycodone (968 452 tablets; 16.0% in July 2013), which appeared to have little impact on the overall rate of controlled‐release oxycodone dispensing in Canada. However, the uptake of generic non‐tamper‐deterrent oxycodone varied considerably by province. By April 2016, 55.0% of all controlled‐release oxycodone tablets dispensed in Quebec were for the generic formulation. Elsewhere in Canada, this prevalence was less than 30%, ranging between 1.6% (Prince Edward Island) and 26.9% (British Columbia) at the end of our study period. Conclusions The changing availability of tamper‐deterrent and non‐tamper‐deterrent formulations of controlled‐release oxycodone in Canada has had variable influence on the rate of use of these products across Canada. Future research should explore whether the availability of generic controlled‐release oxycodone has led to measurable changes in the safety of oxycodone use in Canada.
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Affiliation(s)
- Tara Gomes
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, Toronto, Ontario, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Sonia Jain
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - J Michael Paterson
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, Toronto, Ontario, Canada.,Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ingrid Sketris
- College of Pharmacy, Dalhouse University, Halifax Regional Municipality, Nova Scotia, Canada
| | - Patricia Caetano
- Faculty of Health Sciences, University of Manitoba, Manitoba, Canada.,Provincial Drug Programs, Government of Manitoba, Manitoba, Canada
| | - David Henry
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, Toronto, Ontario, Canada.,Centre for Research in Evidence-based Practice, Bond University, Gold Coast, Australia
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