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Attisso E, Guenette L, Dionne CE, Kröger E, Dialahy I, Tessier S, Jean S. New opioid prescription claims and their clinical indications: results from health administrative data in Quebec, Canada, over 14 years. BMJ Open 2024; 14:e077664. [PMID: 38589264 PMCID: PMC11015182 DOI: 10.1136/bmjopen-2023-077664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 03/27/2024] [Indexed: 04/10/2024] Open
Abstract
OBJECTIVES Describe new opioid prescription claims, their clinical indications and annual trends among opioid naïve adults covered by the Quebec's public drug insurance plan (QPDIP) for the fiscal years 2006/2007-2019/2020. DESIGN AND SETTING A retrospective observational study was conducted using data collected between 2006/2007 and 2019/2020 within the Quebec Integrated Chronic Disease Surveillance System, a linkage administrative data. PARTICIPANTS A cohort of opioid naïve adults and new opioid users was created for each study year (median number=2 263 380 and 168 183, respectively, over study period). INTERVENTION No. MAIN OUTCOME MEASURE AND ANALYSES A new opioid prescription was defined as the first opioid prescription claimed by an opioid naïve adult during a given fiscal year. The annual incidence proportion for each year was then calculated and standardised for age. A hierarchical algorithm was built to identify the most likely clinical indication for this prescription. Descriptive and trend analyses were performed. RESULTS There was a 1.7% decrease of age-standardised annual incidence proportion during the study period, from 7.5% in 2006/2007 to 5.8% in 2019/2020. The decrease was highest after 2016/2017, reaching 5.5% annual percentage change. Median daily dose and days' supply decreased from 27 to 25 morphine milligram equivalent/day and from 5 to 4 days between 2006/2007 and 2019/2020, respectively. Between 2006/2007 and 2019/2020, these prescriptions' most likely clinical indications increased for cancer pain from 34% to 48%, for surgical pain from 31% to 36% and for dental pain from 9% to 11%. Inversely, the musculoskeletal pain decreased from 13% to 2%. There was good consistency between the clinical indications identified by the algorithm and prescriber's specialty or user's characteristics. CONCLUSIONS New opioid prescription claims (incidence, dose and days' supply) decreased slightly over the last 14 years among QPDIP enrollees, especially after 2016/2017. Non-surgical and non-cancer pain became less common as their clinical indication.
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Affiliation(s)
- Eugene Attisso
- Quebec National Institute of Public Health, Quebec, Quebec, Canada
| | - Line Guenette
- Faculty of Pharmacy, Laval University, Quebec, Quebec, Canada
- Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Clermont E Dionne
- Centre de recherche du CHU de Québec-Université Laval, Quebec, Quebec, Canada
- Faculty of Medicine, Laval University, Quebec, Quebec, Canada
| | - Edeltraut Kröger
- Faculty of Pharmacy, Laval University, Quebec, Quebec, Canada
- Sustainable Health Research Centre, VITAM, Quebec, Quebec, Canada
| | - Isaora Dialahy
- Quebec National Institute of Public Health, Quebec, Quebec, Canada
| | | | - Sonia Jean
- Quebec National Institute of Public Health, Quebec, Quebec, Canada
- Faculty of Medicine, Laval University, Quebec, Quebec, Canada
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Shinkai M, Katsumata N, Kawai S, Kuyama S, Sasaki O, Yanagita Y, Yoshida M, Uneda S, Tsuji Y, Harada H, Nishida Y, Sakamoto Y, Himeji D, Arioka H, Sato K, Katsuki R, Shomura H, Nakano H, Ohtani H, Sasaki K, Adachi T. Phase III study of bilayer sustained-release tramadol tablets in patients with cancer pain: a double-blind parallel-group, non-inferiority study with immediate-release tramadol capsules as an active comparator. Support Care Cancer 2023; 32:69. [PMID: 38157081 PMCID: PMC10756890 DOI: 10.1007/s00520-023-08242-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/06/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE We investigated whether twice-daily administration of a bilayer tablet formulation of tramadol (35% immediate-release [IR] and 65% sustained-release) is as effective as four-times-daily IR tramadol capsules for managing cancer pain. METHODS This randomized, double-blind, double-dummy, active-comparator, non-inferiority study enrolled opioid-naïve patients using non-steroidal anti-inflammatory drugs or acetaminophen (paracetamol) to manage cancer pain and self-reported pain (mean value over 3 days ≥ 25 mm on a 100-mm visual analog scale [VAS]). Patients were randomized to either bilayer tablets or IR capsules for 14 days. The starting dose was 100 mg/day and could be escalated to 300 mg/day. The primary endpoint was the change in VAS (averaged over 3 days) for pain at rest from baseline to end of treatment/discontinuation. RESULTS Overall, 251 patients were randomized. The baseline mean VAS at rest was 47.67 mm (range: 25.6-82.7 mm). In the full analysis set, the adjusted mean change in VAS was - 22.07 and - 19.08 mm in the bilayer tablet (n = 124) and IR capsule (n = 120) groups, respectively. The adjusted mean difference was - 2.99 mm (95% confidence interval [CI] - 7.96 to 1.99 mm). The upper 95% CI was less than the predefined non-inferiority margin of 7.5 mm. Other efficacy outcomes were similar in both groups. Adverse events were reported for 97/126 (77.0%) and 101/125 (80.8%) patients in the bilayer tablet and IR capsule groups, respectively. CONCLUSION Twice-daily administration of bilayer tramadol tablets was as effective as four-times-daily administration of IR capsules regarding the improvement in pain VAS, with comparable safety outcomes. CLINICAL TRIAL REGISTRATION JapicCTI-184143/jRCT2080224082 (October 5, 2018).
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Affiliation(s)
| | | | | | - Shoichi Kuyama
- National Hospital Organization Iwakuni Clinical Center, Yamaguchi, Japan
| | | | | | | | - Shima Uneda
- Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | | | | | | | | | | | | | | | - Ryo Katsuki
- National Hospital Organization Ureshino Medical Center, Saga, Japan
| | - Hiroki Shomura
- Japan Community Health Care Organization Hokkaido Hospital, Hokkaido, Japan
| | - Hideshi Nakano
- Department of Clinical Development, Nippon Zoki Pharmaceutical Co., Ltd., Osaka, Japan
| | - Hideaki Ohtani
- Department of Clinical Development, Nippon Zoki Pharmaceutical Co., Ltd., Osaka, Japan
| | - Kazutaka Sasaki
- Department of Clinical Development, Nippon Zoki Pharmaceutical Co., Ltd., Osaka, Japan
| | - Takeshi Adachi
- Department of Clinical Development, Nippon Zoki Pharmaceutical Co., Ltd., Osaka, Japan
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Eriksen AMA, Melhus M, Schei B, Skurtveit S, Broderstad AR. Opioid prescriptions among Sami and non-Sami with chronic pain: The SAMINOR 2 Questionnaire Survey and the Norwegian Prescription Database. Int J Circumpolar Health 2023; 82:2241202. [PMID: 37506380 PMCID: PMC10392314 DOI: 10.1080/22423982.2023.2241202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
This study is the first to investigate the prevalence of filled opioid prescriptions among indigenous Sami people with self-reported chronic musculoskeletal pain (CMSP) and compare it with that of non-Sami living in the same area. Baseline data from the SAMINOR 2 Questionnaire Survey (2012) was linked prospectively to the Norwegian Prescription Database. Information on filled opioid prescriptions during 2012-2019 was collected for 4767 persons who reported CMSP in SAMINOR 2. Gender-stratified chi-square tests, two-sample t-tests, Kruskal - Wallis tests, and multinomial logistic regression was applied. Two out of three CMSP respondents received no or only one prescription of opioids during 2012-2019. In each year, 80% of women received no opioids, 7-10% received one prescription of ≤ 180 defined daily doses (DDD), 8-9% received in total ≤ 180 DDD in two or more prescriptions, and 2-3% received > 180 DDD of opioids. Among men, 81-83% received no opioids, 8-11% received one prescription with ≤ 180 DDD, 5-9% received ≤ 180 DDD in two or more prescriptions, and 1-2% received > 180 DDD of opioids in a single year. There were no overall ethnic differences, which indicates a similar prescription policy for opioids for Sami and non-Sami with CMSP.
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Affiliation(s)
- Astrid M A Eriksen
- Centre for Sami Health Research, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Marita Melhus
- Centre for Sami Health Research, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Berit Schei
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Norwegian University of Science and Technology (NTNU), Department of Obstetrics and Gynecology, Trondheim, Norway
| | - Svetlana Skurtveit
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ann-Ragnhild Broderstad
- Centre for Sami Health Research, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
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Abstract
This paper is the forty-fifth consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2022 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, USA.
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Hansen CA, Ernst MT, Smith CD, Abrahamsen B. Epidemiological Factors Associated with Prescription of Opioids for Chronic Non-Cancer Pain in Adults: A Country-Wide, Registry-Based Study in Denmark Spans 2004-2018. J Pain Res 2023; 16:463-485. [PMID: 36815123 PMCID: PMC9940488 DOI: 10.2147/jpr.s388674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 01/22/2023] [Indexed: 02/18/2023] Open
Abstract
Purpose Denmark has a high consumption of prescribed opioids, and many citizens with chronic non-cancer pain (CNCP). Therefore, we aimed to characterize and assess epidemiological risk factors associated with long-term non-cancer opioid use among Danish citizens. Patients and Methods We conducted a longitudinal, retrospective, observational, register-based study using nationwide databases containing essential medical, healthcare, and socio-economic information. Statistical analysis, including backward stepwise logistic regression analysis, was used to explain long-term opioid use by individuals filling at least one prescription for an opioid product N02AA01-N02AX06 during 01/01/2004-31/12/2017, follow-up until the end of 2018. Results The analyzed cohort contained N=1,683,713 non-cancer opioid users, of which 979,666 were classified with CNCP diagnosis using ICD-10 codes. Long-term opioid use was predicted by a mean of 1,583.30 and a median of 300 oral morphine equivalent mg (OMEQ) per day during the first year, together with divorced, age group 40-53 years, retirement, receiving social welfare or unemployment ≥6 months. In addition, living in Northern Jutland, co-medications such as beta-blockers, anti-diabetics, anti-rheumatics, and minor surgery ≤90 days before inclusion. Protective variables were an education level of secondary school or higher, children living at home, household income of middle or highest tertile, opioid doses in either the 2nd or 3rd quartile OMEQ, male, the oldest age group, living in the Capital Region or Zealand, co-medication lipid-lowering, one comorbidity, heart failure, surgeries ≤90 days before the index: lips/teeth/jaw/mouth/throat, heart/vessels, elbow/forearm, hip/thigh, knee/lower leg/ankle/foot. Conclusion Long-term opioid users differ epidemiologically from those using opioids for a shorter period. The study findings are essential for future recommendations revision in Denmark and comparable countries.
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Affiliation(s)
- Carrinna Aviaja Hansen
- Department of Orthopedic Surgery, Zealand University Hospital, University of Copenhagen, Koege, Denmark,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark,Department of Anesthesia, Respiratory Support and Pain Management, the Neuroscience Centre, Rigshospitalet, Glostrup, University of Copenhagen, Copenhagen, Denmark,Odense Patient Data Explorative Network, University of Southern Denmark, Odense, Denmark,Correspondence: Carrinna Aviaja Hansen, Zealand University Hospital, University of Copenhagen, Department of Orthopedic Surgery, Lykkebaekvej 1, Koege, 4600, Denmark, Tel +45 9357 6524, Email
| | - Martin Thomsen Ernst
- Odense Patient Data Explorative Network, University of Southern Denmark, Odense, Denmark,Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Christopher Dyer Smith
- Odense Patient Data Explorative Network, University of Southern Denmark, Odense, Denmark
| | - Bo Abrahamsen
- Odense Patient Data Explorative Network, University of Southern Denmark, Odense, Denmark,Department of Medicine, Holbaek Hospital, Holbaek, Denmark
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