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Cebron Lipovec N. Opioid analgesics prescribing trends 2010-2019 in Slovenia: National database study. Hum Psychopharmacol 2024; 39:e2891. [PMID: 38214662 DOI: 10.1002/hup.2891] [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: 04/19/2023] [Revised: 11/06/2023] [Accepted: 12/15/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE Significant increases in global opioid use have been reported in recent decades. This study analyzed opioid utilization in outpatient care in Slovenia between 2010 and 2019. METHODS This retrospective cross-sectional study performed a nationwide database analysis of all outpatient opioid analgesic prescriptions based on Slovenian health insurance claims data. Prevalence was defined as the number of recipients prescribed at least one opioid per 1000 inhabitants. Opioid consumption was presented as the total number of dispensed prescriptions per 1000 inhabitants and dispensed defined daily doses (DDD) per 1000 inhabitants for each year analyzed. RESULTS The age-standardized prevalence of opioid recipients decreased by 21.5% during the study period. Total opioid consumption decreased both in the number of prescriptions (-9.2%) and DDD (-5.4%). Tramadol consumption decreased in terms of the number of prescriptions (-12.2%) and DDD (-2.7%), whereas prescriptions for strong opioids increased (10.2%) and DDDs decreased (-16.2%). The results suggest less intensive prescribing of strong opioids and more intensive prescribing for tramadol. The most frequently used strong opioids were fentanyl and oxycodone/naloxone. CONCLUSIONS The prevalence of opioid recipients and opioid consumption is decreasing in Slovenia. Further research is needed to understand whether this finding reflects safe use or underuse of these important analgesics.
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Engi Z, Benkő R, Soós G, Szok D, Csenki M, Csüllög E, Balog A, Csupor D, Viola R, Doró P, Matuz M. Trends in Opioid Utilisation in Hungary, 2006-2020: A Nationwide Retrospective Study with Multiple Metrics. Eur J Pain 2022; 26:1896-1909. [PMID: 35848717 PMCID: PMC9541344 DOI: 10.1002/ejp.2011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/01/2022] [Accepted: 07/16/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Opioid use is well-documented in several countries: some countries struggle with overuse while others have almost no access to opioids. For Europe, limited data are available. This study analysed Hungarian opioid utilisation in ambulatory care between 2006 and 2020. METHODS We obtained national drug utilization data on reimbursed opioid analgesics (ATC code: N02A) from a national health insurance database for a 15-year period. We investigated utilisation trends, using three volume-based metrics (defined daily dose per 1000 inhabitants per day (DID), oral morphine equivalent per 1000 inhabitants per day, packages dispensed per 1000 inhabitants per year). We stratified data based on administration routes, analgesic potency and reimbursement categories. RESULTS Total opioid utilisation increased during the study period according to all three metrics (74% in DID) and reached 5.31 DID by 2020. Upward trends were driven by an increase both in weak and strong opioid use (79% vs. 53%). The most commonly used opioids were fentanyl (in the strong category; 0.76 DID in 2020) and tramadol (in the weak category; 2.62 DID in 2020). Overall, tramadol was also the most commonly used opioid throughout the study period. Oral administration of opioid medications was dominant. Based on reimbursement categories, musculoskeletal pain was becoming a more frequent indication for opioid use (1552% increase in DID), while opioid use for cancer pain declined significantly during the study period (-33% in DID). CONCLUSIONS Our low utilisation numbers might indicate underuse of opioid analgesia, especially for cancer pain.
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Affiliation(s)
- Z Engi
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725, Szeged, Hungary
| | - R Benkő
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725, Szeged, Hungary.,Central Pharmacy Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725, Szeged, Hungary.,Emergency Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725, Szeged, Hungary
| | - G Soós
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725, Szeged, Hungary
| | - D Szok
- Department of Neurology, Albert Szent-Györgyi Health Center, University of Szeged, 6725, Szeged, Hungary
| | - M Csenki
- Department of Oncotherapy, Albert Szent-Györgyi Health Center, University of Szeged, 6725, Szeged, Hungary
| | - E Csüllög
- Department of Anesthesiology and Intensive Care, Albert Szent-Györgyi Health Center, 6725, University of Szeged, Szeged, Hungary
| | - A Balog
- Department of Rheumatology and Immunology, Albert Szent-Györgyi Health Center, University of Szeged, 6725, Szeged, Hungary
| | - D Csupor
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725, Szeged, Hungary.,Institute for Translational Medicine, Medical School, University of Pécs, 7624, Pécs, Hungary
| | - R Viola
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725, Szeged, Hungary
| | - P Doró
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725, Szeged, Hungary
| | - M Matuz
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725, Szeged, Hungary.,Central Pharmacy Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725, Szeged, Hungary
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Richards GC, Aronson JK, Mahtani KR, Heneghan C. Global, regional, and national consumption of controlled opioids: a cross-sectional study of 214 countries and non-metropolitan territories. Br J Pain 2022; 16:34-40. [PMID: 35111312 PMCID: PMC8801686 DOI: 10.1177/20494637211013052] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The consumption of opioids has increased globally since the 1990s. Previous studies of global opioid consumption have concentrated on morphine alone or a subset of opioids, with a focus on cancer pain and palliative care. In this study, we have determined the global, regional, and national consumption of all controlled opioids, including anaesthetics, analgesics, antidiarrheals, opioid substitution therapies, and cough suppressants. METHODS We conducted a cross-sectional study using data from the International Narcotics Control Board (INCB). We calculated mean opioid consumption (mg/person) globally, regionally, and nationally for 2015-2017, where consumption refers to the total amount of controlled opioids distributed for medical purposes and excludes recreational use. We ranked countries by total consumption and quantified the types of opioids consumed globally. RESULTS Between 2015 and 2017, 90% of the world's population consumed only 11% of controlled opioids. An average of 32 mg/person was consumed annually, but this was not equally distributed across the world. Consumption was the highest in Germany (480 mg/person), followed by Iceland (428 mg/person), the United States (398 mg/person) and Canada (333 mg/person). Oxycodone (35%) was the most heavily consumed controlled opioid globally, followed by morphine (15.9%), methadone (15.8%) and tilidine (14%). CONCLUSION Large disparities persist in most of the world in accessing essential opioid medicines. Consumption patterns should continue to be monitored, and collaborative strategies should be developed to promote access and the appropriate prescribing of opioids in all countries and non-metropolitan territories.
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Affiliation(s)
- Georgia C Richards
- Global Centre on Healthcare and Urbanisation, Kellogg College, University of Oxford, Oxford, UK
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jeffrey K Aronson
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kamal R Mahtani
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Carl Heneghan
- Global Centre on Healthcare and Urbanisation, Kellogg College, University of Oxford, Oxford, UK
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Dupoiron D. Cancer Pain Management-A European Perspective. Cancer Treat Res 2021; 182:39-55. [PMID: 34542875 DOI: 10.1007/978-3-030-81526-4_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Cancer pain management is a major challenge in both Europe and the United States. Recent studies show that the incidence of cancer pain remains high and even increases at an advanced stage of the disease.
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Affiliation(s)
- Denis Dupoiron
- Anesthesia and Pain Department, Institut de Cancérologie de l'Ouest, Rue Boquel, 49055, Angers, France.
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Abstract
OBJECTIVES To provide an overview of the global disparities in cancer pain management. To discuss cultural, religious, and spiritual considerations in cancer pain assessment and management. DATA SOURCES Peer-reviewed articles, book chapters, Internet. CONCLUSION Significant disparities in pain management exist globally, especially in developing countries. Cultural and religious differences influence pain care and opioid availability is lacking in many countries. Significant barriers impede good pain management; however, some countries have made positive strides in improving pain management for their population. IMPLICATIONS FOR NURSING PRACTICE Globally, nurses have a vital role in recognizing and addressing barriers to good pain management and can be ambassadors to advocate for improved pain assessment and management globally.
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Affiliation(s)
- Gülbeyaz Can
- Istanbul University - Cerrahpasa, Florence Nightingale Nursing Faculty, Abide-i Hurriyet Cad, Caglayan, Istanbul, Turkey
| | - Tayreez Mushani
- University Health Network, Toronto, ON, Canada; Aga Khan University School of Nursing and Midwifery, Nairobi
| | | | - Jeannine M Brant
- Collaborative Science and Innovation, Billings Clinic, Billings, MT, USA.
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Bosetti C, Santucci C, Radrezza S, Erthal J, Berterame S, Corli O. Trends in the consumption of opioids for the treatment of severe pain in Europe, 1990–2016. Eur J Pain 2018; 23:697-707. [DOI: 10.1002/ejp.1337] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/09/2018] [Accepted: 10/28/2018] [Indexed: 01/17/2023]
Affiliation(s)
- Cristina Bosetti
- Laboratory of Methodology for Clinical Research Department of Oncology Istituto di Ricerche Farmacologiche Mario Negri IRCCS Milan Italy
| | - Claudia Santucci
- Laboratory of Methodology for Clinical Research Department of Oncology Istituto di Ricerche Farmacologiche Mario Negri IRCCS Milan Italy
| | - Silvia Radrezza
- Laboratory for Medical Research and Consumer Involvement Department of Public Health Istituto di Ricerche Farmacologiche Mario Negri IRCCS Milan Italy
| | - Juliana Erthal
- Secretariat of the International Narcotics Control Board Vienna International Centre Vienna Austria
| | - Stefano Berterame
- Secretariat of the International Narcotics Control Board Vienna International Centre Vienna Austria
| | - Oscar Corli
- Unit of Pain and Palliative Care Research Department of Oncology Istituto di Ricerche Farmacologiche Mario Negri IRCCS Milan Italy
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Scholten WK, Christensen AE, Olesen AE, Drewes AM. Quantifying the Adequacy of Opioid Analgesic Consumption Globally: An Updated Method and Early Findings. Am J Public Health 2018; 109:52-57. [PMID: 30496006 DOI: 10.2105/ajph.2018.304753] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Opioid analgesics are the mainstay for treatment of moderate and severe pain but, in many countries, the consumption of these medicines is inadequate. Over time, various groups have published opioid analgesic metrics, including authors from the World Health Organization. They linked consumption to a level considered adequate based on the actual consumption in developed countries. In this study, we present our current results on the adequacy of opioid analgesic consumption. We included statistics for 18 controlled opioid medicines that are primarily used as analgesics, and we developed the Adequacy of Opioid Consumption (AOC) Index. The average of the 20 most developed countries for 2015 is set as equal to an AOC Index of 100. An AOC Index of 100 or higher is considered adequate consumption. The average opioid analgesic consumption of the top-20 countries of the Human Development Index increased from 84 morphine milligram equivalents per capita (2000) to 256 morphine milligram equivalents per capita (2015). The extremes we found for 2015 were Germany (AOC Index: 304) and Nigeria (AOC Index: 0.0069). These extremes differ by 44 000 times. Adequacy of opioid analgesic consumption continues to be problematic around the world.
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Affiliation(s)
- Willem K Scholten
- Willem K. Scholten is with Mech-Sense, Aalborg University Hospital, Aalborg, Denmark, and Willem Scholten Consultancy, Lopik, the Netherlands. Ann-Eva Christensen is with the Unit of Epidemiology and Biostatistics, Aalborg University Hospital. Anne Estrup Olesen and Asbjørn Mohr Drewes are with Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, and Department of Clinical Medicine, Aalborg University, Aalborg. Anne Estrup Olesen is also with Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ann-Eva Christensen
- Willem K. Scholten is with Mech-Sense, Aalborg University Hospital, Aalborg, Denmark, and Willem Scholten Consultancy, Lopik, the Netherlands. Ann-Eva Christensen is with the Unit of Epidemiology and Biostatistics, Aalborg University Hospital. Anne Estrup Olesen and Asbjørn Mohr Drewes are with Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, and Department of Clinical Medicine, Aalborg University, Aalborg. Anne Estrup Olesen is also with Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Estrup Olesen
- Willem K. Scholten is with Mech-Sense, Aalborg University Hospital, Aalborg, Denmark, and Willem Scholten Consultancy, Lopik, the Netherlands. Ann-Eva Christensen is with the Unit of Epidemiology and Biostatistics, Aalborg University Hospital. Anne Estrup Olesen and Asbjørn Mohr Drewes are with Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, and Department of Clinical Medicine, Aalborg University, Aalborg. Anne Estrup Olesen is also with Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Asbjørn Mohr Drewes
- Willem K. Scholten is with Mech-Sense, Aalborg University Hospital, Aalborg, Denmark, and Willem Scholten Consultancy, Lopik, the Netherlands. Ann-Eva Christensen is with the Unit of Epidemiology and Biostatistics, Aalborg University Hospital. Anne Estrup Olesen and Asbjørn Mohr Drewes are with Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, and Department of Clinical Medicine, Aalborg University, Aalborg. Anne Estrup Olesen is also with Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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