Opioid use trends in Spain: the case of the island of La Gomera (2016–2019)

Abstract This study is an evaluation of prescription opioid use on the island of La Gomera, a mainly rural area, during the period 2016–2019 at various levels. Data were extracted from the wholesalers who supply the community pharmacies at the population level. Prescription opioid use was measured as defined daily doses per 1,000 inhabitants/day (DID) and by the number of units sold per 1,000 inhabitants and year (units sold). This provided an island total of La Gomera’s overall prescription of opioids and its rate of change, as well as differences in prescribing at the municipal and health area level. Tramadol with acetaminophen and tramadol in monotherapy were the most consumed by “units sold” parameter, which accounted for 69.48% and 18.59% of the total. The situation was similar for DID, although with lower percentages, but a significant increase was observed in the use of fentanyl and buprenorphine, around 15% in each case. The balance between the uses of weak or strong opioids was different in La Gomera compared to that of Spain as a whole. In Spain, almost 70% of the prescriptions were for weak opioids compared to 58.67% in La Gomera. Fentanyl was the most used strong opioid (16.10%) followed by tapentadol and buprenorphine, around 5% each, whereas in La Gomera, buprenorphine was the most consumed (15.75%) followed by fentanyl (14.87%) and tapentadol (5.82%). These differences in prescription opioid use are most likely explained by prescriber characteristics, whereas the population age, socioeconomic status, or living in rural/urban area are not decisive determinants.

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Opioid Consumption Trends in Spain: The Case of the Island of La Gomera (2016-2019)

10.21203/rs.3.rs-484651/v1 ◽

2021 ◽

Author(s):

Alexis Oliva ◽

Néstor Armas ◽

Sandra Devora ◽

Susan Abdala

Keyword(s):

Classification System ◽

Population Level ◽

Consumption Patterns ◽

Community Pharmacies ◽

Sociodemographic Characteristics ◽

Prescribing Habits ◽

Defined Daily Doses ◽

Opioid Drugs ◽

Strong Opioids ◽

La Gomera

Abstract This study aimed to describe the consumption of opioid drugs in the island of La Gomera over a four-year period (2016–2019) at various levels (island, township and health areas). Data were extracted from the wholesaler in community pharmacies at a population level. Consumption patterns were expressed as number of Defined Daily Doses per 1000 inhabitant /day (DID) and by the number of sold units per 1000 inhabitants and year. A common classification system (ATC) and the two units of measurement proposed enabled comparisons at various levels. Major differences between island, township, and health areas are presented. Little is known about the reasons for these differences. The opioids belonging to the N02AJ groups and N02AX were the most consumed according to the “sold units” parameter, which accounted for 69.48% and 18.59%, respectively. The situation was similar in terms of DID, although with lower percentages, but a significative increase was observed in the use of fentanyl and buprenorphine, around 15% each. The balance between the uses of weak or strong opioids showed differences in La Gomera compared to those nationwide. In mainland Spain, almost 70% of the consumption came from weak opioids versus that of 58.67% in La Gomera. Fentanyl was the most frequently used strong opioid (16.10%) followed by tapentadol and buprenorphine, around 5% each, whereas in La Gomera buprenorphine was the most consumed (15.75%) followed by fentanyl (14.87%) and tapentadol (5.82%). These differences in opioids consumption are most likely explained by different changes on the prescribing habits and sociodemographic characteristics.

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Patterns, trends and determinants of medical opioid utilization in Canada 2005–2020: characterizing an era of intensive rise and fall

Substance Abuse Treatment Prevention and Policy ◽

10.1186/s13011-021-00396-5 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Wayne Jones ◽

Ridhwana Kaoser ◽

Benedikt Fischer

Keyword(s):

Population Level ◽

Prescription Opioid ◽

Policy And Practice ◽

Marked Rise ◽

Strong Opioid ◽

Defined Daily Doses ◽

Care Outcomes ◽

Opioid Medications ◽

Strong Opioids ◽

Over Time

Abstract Background Into the 21st century, the conflation of high rates of chronic pain, systemic gaps in treatment availability and access, and the arrival of potent new opioid medications (e.g., slow-release oxycodone) facilitated strong increases in medical opioid dispensing in Canada. These persisted until post-2010 alongside rising opioid-related adverse (e.g., morbidity/mortality) outcomes. We examine patterns, trends and determinants of opioid dispensing in Canada, and specifically its 10 provinces, for the years 2005–2020. Methods Raw data on prescription opioid dispensing were obtained from a large national community-based pharmacy database (IQVIA/Compuscript), converted into Defined-Daily-Doses/1,000 population/day for ‘strong’ and ‘weak’ opioid categories per standard methods. Dispensing by opioid category and formulations by province/year was assessed descriptively; regression analysis was applied to examine possible segmentation of over-time strong opioid dispensing. Results All provinces reported starkly increasing strong opioid dispensing peaking 2011–2016, and subsequent marked declines. About half reported lower strong opioid dispensing in 2020 compared to 2005, with continuous inter-provincial differences of > 100 %; weak opioids also declined post-2011/12. Segmented regression suggests breakpoints for strong opioids in 2011/12 and 2015/16, coinciding with main interventions (e.g., selective opioid delisting, new prescribing guidelines) towards more restrictive opioid utilization control. Conclusions We characterized an era of marked rise and fall, while featuring stark inter-provincial heterogeneity in opioid dispensing in Canada. While little evidence for improvements in pain care outcomes exists, the starkly inverting opioid utilization have been associated with extensive population-level harms (e.g., misuse, morbidity, mortality) over-time. This national case study raises fundamental questions for opioid-related health policy and practice.

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Prescription opioid dispensing in Canada: an update on recent developments to 2018

Journal of Pharmaceutical Policy and Practice ◽

10.1186/s40545-020-00271-x ◽

2020 ◽

Vol 13 (1) ◽

Author(s):

Wayne Jones ◽

Lenka Vojtila ◽

Paul Kurdyak ◽

Benedikt Fischer

Keyword(s):

Control Measures ◽

Prescription Opioid ◽

Opioid Use ◽

Community Based ◽

Defined Daily Doses ◽

Sample Data ◽

Recent Developments ◽

Strong Opioids ◽

Dispensing Data ◽

Illicit Opioid Use

Abstract Canada has been home to comparatively extreme developments in prescription opioid (PO) availability and related harms (e.g. morbidity, mortality) post-2000. Following persistent pan-Canadian increases in PO use, select control measures were implemented and PO dispensing levels—while only inconsistently by province—inverted, and began to plateau or decrease post-2012. We examined annual PO dispensing levels in Canada up until 2018, based on representative prescription sample data from community-based retail pharmacies. Annual prescription-based dispensing data were converted into defined daily doses/1000 population/day by province, and mainly categorized into ‘weak’ and ‘strong’ opioids. All provinces indicated decreasing trends in strong PO levels in most recent years, yet with inter-provincial differences of up to one magnitude in 2018; in about half the provinces, dispensing fell to below-2005 levels. British Columbia had the largest decline in strong PO dispensing from its peak rate (− 48.5%) in 2011. Weak opioid dispensing trends remained more inconsistent and bifurcated across Canada. The distinct effects of individual—including many provincially initiated and governed—PO control measures urgently need to be evaluated. In the meantime, recent reductions in general PO availability across Canada appear to have contributed to shortages in opioid supply for existent, sizable (including non-medical) user populations and may have contributed to recent marked increases in illicit opioid use and harms (including rising deaths).

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Prescription Opioid Use and Concurrent Psychotropic Drug Use During Pregnancy: A Population-Based Retrospective Cohort Study Utilizing Linked Administrative Data

International Journal for Population Data Science ◽

10.23889/ijpds.v3i4.976 ◽

2018 ◽

Vol 3 (4) ◽

Author(s):

Deepa Singal ◽

Dan Chateau ◽

Matthew Dahl ◽

Shelley Derksen ◽

Laurence Katz ◽

...

Keyword(s):

Drug Use ◽

Pregnant Women ◽

Administrative Data ◽

Psychotropic Drug ◽

Population Level ◽

Population Based ◽

Prescription Opioid ◽

Prescription Opioids ◽

Opioid Use ◽

Prescription Opioid Use

IntroductionIt is important to investigate the use of prescription opioids during pregnancy to gain insight into the potential impact of maternal opioid exposure during pregnancy on children. We report the prevalence of prescription opioid use and concurrent psychotropic drug use in a large, Canadian population-based cohort of pregnant women. Objectives and ApproachUsing population-level linked administrative data from a universal health care system, this study included all women with a live birth in Manitoba from 1996 to 2014. Dispensing of opioids was determined from prescription drug data. Patterns of prescription opioids dispensed to pregnant women were investigated by demographic characteristics, region of residence, and socioeconomic status. Concurrent psychotropic therapies were also measured. These data address limitations associated with re-call bias, cilitate longitudinal analaysis, and allow the investigation of rare outcomes, difficult to study using other data sources. ResultsIn a large population level sample of pregnancies (N=245,784), 2.43% of pregnancies were exposed to 2+ dispensations of opioids. An additional 4.95% of pregnancies recorded at a single opioid dispensation. Compared to women who were not dispensed any opioid prescriptions, the proportion of opioid exposed pregnancies who were also prescribed anti-depressants (SSRI/SNRI) was sevenfold higher (22.5% vs 3.05%). The same pattern was found for anxiolytics (37.2% vs 1.5%) and antipsychotics (3.5% vs 0.34%). Conclusion/ImplicationsThese data demonstrate high proportions of women were dispensed opioids during pregnancy. Further research should be done on the short term and long term effects of these medications on infants and children. Moreover, these results highlight the need for further investigation into the effects of exposure to multiple psychotropic drugs

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