Global consumption of prescription opioid analgesics between 2009-2019: a country-level observational study

Jayawardana, Sahan; Forman, Rebecca; Johnston-Webber, Charlotte; Campbell, Allen; Berterame, Stefano; Joncheere, Cees de; Aitken, Murray; Mossialos, Elías

doi:10.1016/j.eclinm.2021.101198

Cited by 47 publications

(47 citation statements)

References 35 publications

(45 reference statements)

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“…Comparing this study of BEACH data with other studies concerning prescribed opioids, a recent study of Australian pharmaceutical dispensing data, similarly found that opioid dispensing increased almost four-fold between 1990 to 2014 with the growth in opioid dispensing slowing in the second half of the study period, presumably related to policy and systems level change to reduce prescribed opioid misuse (2). Further, another study (17) estimating global patterns of prescribed opioid consumption found that in 2019 Australia was one of the highest opioid consuming countries (ranked 8th behind the UK, Germany, US, Canada, Spain, Belgium and Denmark) and across 2009 to 2019 there was little change (increase or decrease) in Australia's prescribed opioid consumption rate in morphine milligram equivalents per 1000 inhabitants per day.…”

Section: Discussionsupporting

confidence: 71%

Opioid prescribing in general practice: an Australian cross-sectional survey

et al. 2022

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Background Prescribed opioid doses > 100 mg oral morphine equivalent (OME) and/or co-prescribing of sedating psychoactive medications increase the risk of unintentional fatal overdose. We describe general practice encounters where opioids are prescribed and examine high-risk opioid prescribing. Methods The 2006–2016 BEACH study data, a rolling national cross-sectional survey of randomly selected GPs, was analysed. Results Opioid prescribing increased 2006–2007 to 2015–2016, however, this plateaued across the latter half-decade. From 2012–2016 3,897 GPs recorded 389,700 encounters and at least one opioid was prescribed at 5.2%. Opioid encounters more likely involved males, those 45–64 years, concession card holders and the socioeconomically disadvantaged. GPs more likely to prescribe opioids were 55 years or older, male, Australian graduates, and in regional and remote areas. The most common problems managed with opioids involved chronic non-cancer pain. One-in-ten opioid prescribing episodes involved high-risk doses and 11% involved co-prescription of sedating psychoactive medications. Over one-third of GPs provided other (non-pharmacological) interventions at encounters with opioid prescriptions. Conclusions Only 5% of GP encounters involved an opioid prescription. Of concern, were: prescribing for chronic non-cancer pain, potentially high-risk opioid encounters where > 100 OME daily dose was prescribed, and/or there was co-prescription of sedating psychoactive medication. However, approximately one-in-three opioid prescribing encounters involved non-pharmacological interventions.

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Section: Discussionsupporting

confidence: 71%

Opioid prescribing in general practice: an Australian cross-sectional survey

et al. 2022

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“…2021 MME per capita use declined to 309 ( 19 ), a level last seen in 2000, while the over 55 population with its age-related health conditions increased by 40 million since then and COVID care has required “high demand.” “Forty-seven states and the District of Columbia have laws that set time or dosage limits for controlled substances ( 20 ).” “All 50 states have established prescription drug monitoring programs (PDMPs) ( 21 )” to collect and surveil doctor, patient, and dispensed medication information. Since 2009, U.S. morphine milligram equivalents per 1,000 inhabitants per day (MID) declined by 48% from second in the world ( 22 ) to third in 2019 ( 23 ).…”

Section: Background and Rationalementioning

confidence: 99%

Overdose, opioid treatment admissions and prescription opioid pain reliever relationships: United States, 2010–2019

Aubry

Carr²

2022

Front. Pain Res.

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Background“As part of the U.S. government's urgent response to the epidemic of overdose deaths (1)” the United States Centers for Disease Control and Prevention (CDC) issued the “CDC Guideline for Prescribing Opioids for Chronic Pain-United States, 2016 (2)” (guideline) followed by the “CDC Clinical Practice Guideline for Prescribing Opioids–United States, 2022 (3) (guideline update). ” The guideline and guideline update cite a direct correlation between prescription opioids sales (POS) and opioid treatment admissions (OTA) and prescription opioid deaths (POD), which was based on data from 1999 to 2010. This paper updates those relationships and includes the correlations between prescription opioid sales (POS) and any opioid deaths (AOD) and total overdose deaths (TOD) from 2010 to 2019.MethodsLinear regression models were fit to each response separately. Opioid sales (measured as MME (morphine milligram equivalent) per capita) was the independent variable. Total overdose deaths (TOD), any opioid overdose deaths (AOD), prescription opioid overdose deaths (POD) and opioid treatment admissions (OTA) were the dependent, response variables. The models were assessed using three criteria: the statistical significance of the model (Overall P-Value), the quality of the fit (R2), and the sign of the slope coefficient (positive or negative).ResultsThe analyses revealed that the direct correlations (i.e., significant, positive slopes) reported by the CDC based on data from 1999 to 2010 no longer exist. Based on data from 2010 to 2019, the relationships either have reversed (i.e., significant, negative slopes) or are non-existent (i.e., no significant model).ConclusionsThe guideline, guideline update, CDC's public, medical profession, and intergovernmental communications should be corrected/updated to state no direct correlation has existed between POS to OTA, POD, AOD, and TOD since 2010. Individualized patient care and public health policy should be amended accordingly.

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“…The concept of opioid stewardship programs (OSPs) was encouraged by the successful implementation of antibiotic stewardship programs (ASPs). Appropriate use of opioid Kim, et al analgesics for terminal patients with painful malignancies has been considered a human right, and the amount of opioid consumption (morphine milligram equivalent per day [MME/d]) per 1,000 inhabitants was also once an indicator of being an advanced country [2].…”

Section: Introductionmentioning

confidence: 99%

Prevention, diagnosis, and treatment of opioid use disorder under the supervision of opioid stewardship programs: it’s time to act now

et al. 2022

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The third opium war may have already started, not only due to illicit opioid trafficking from the Golden Crescent and Golden Triangle on the international front but also through indiscriminate opioid prescription and opioid diversion at home. Opioid use disorder (OUD), among unintentional injuries, has become one of the top 4 causes of death in the United States (U.S.). An OUD is defined as a problematic pattern of opioid use resulting in clinically significant impairment or distress, consisting of 2 or more of 11 problems within 1 year, as described by the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition. Observation of aberrant behaviors of OUD is also helpful for overworked clinicians. For the prevention of OUD, the Opioid Risk Tool and the Current Opioid Misuse Measure are appropriate screening tests before and during opioid administration, respectively. Treatment of OUD consists of 3 opioid-based U.S. Food and Drug Administration-approved medications, including methadone, buprenorphine, and naltrexone, and non-opioid-based symptomatic medications for reducing opioid withdrawal syndromes, such as α 2 agonists, β-blockers, antidiarrheals, antiemetics, non-steroidal anti-inflammatory drugs, and benzodiazepines. There are at least 6 recommendable guidelines and essential terms related to OUD. Opioid stewardship programs are now critical to promoting appropriate use of opioid medications, improving patient outcomes, and reducing misuse of opioids, influenced by the successful implementation of antimicrobial stewardship programs. Despite the lack of previous motivation, now is the critical time for trying to reduce the risk of OUD.

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Global consumption of prescription opioid analgesics between 2009-2019: a country-level observational study

Cited by 47 publications

References 35 publications

Opioid prescribing in general practice: an Australian cross-sectional survey

Opioid prescribing in general practice: an Australian cross-sectional survey

Overdose, opioid treatment admissions and prescription opioid pain reliever relationships: United States, 2010–2019

Prevention, diagnosis, and treatment of opioid use disorder under the supervision of opioid stewardship programs: it’s time to act now

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