Prescribed opioid analgesic use developments in three Nordic countries, 2006–2017

Abstract

<jats:title>Abstract</jats:title> <jats:sec id="j_sjpain-2018-0307_s_999"> <jats:title id="d2672598e40833">Background and aims</jats:title> <jats:p>While the Nordic countries have considerably stricter controls on opioid prescribing for chronic non-cancer pain than other countries, previous research has warned that prescription of strong opioids is increasing. This study examines consumption of and developments in dispensed prescribed opioids to individuals receiving ambulatory care from 2006 to 2017, using publicly available data from each of three Nordic countries’ national prescription registries.</jats:p></jats:sec> <jats:sec id="j_sjpain-2018-0307_s_998"> <jats:title id="d2672598e40841">Methods</jats:title> <jats:p>Repeated, cross-sectional design. One-year prevalence of all dispensed prescribed opioids in ATC N02A group were reported for Norway, Denmark, and Sweden in the period 2006–2017 by gender. One-year prevalence of the weak opioids tramadol and codeine and the strong opioid oxycodone were then reported separately over this period for each country. The mean defined daily dose (DDD) per user per year, an estimate of the amount of opioids prescribed, was reported for each of the three opioids in 2016.</jats:p></jats:sec> <jats:sec id="j_sjpain-2018-0307_s_997"> <jats:title id="d2672598e40849">Results</jats:title> <jats:p>Patterns of dispensed prescribed opioids differ greatly between 2006 and 2017 and between countries, with tramadol increasing in Norway, codeine declining across the board, and oxycodone increasing in all three countries. Norway exceeded Sweden and Denmark in prevalence of all dispensed prescribed opioids, with 12.1% of the female Norwegian population and 9.2% of the male Norwegian population dispensed at least one prescribed opioid as an outpatient in 2016. Norway’s high overall prevalence rates are tempered by dispensing the lowest mean doses of both weak opioids compared to Sweden. Similarly, Sweden dispenses the lowest mean doses of oxycodone but to the largest proportion of its population (3.0%).</jats:p></jats:sec> <jats:sec id="j_sjpain-2018-0307_s_996"> <jats:title id="d2672598e40857">Conclusions</jats:title> <jats:p>Significant shifts have occurred in the dispensing of prescribed opioids in Norway, Sweden, and Denmark over the past 12 years. The increasing prevalence of oxycodone in all three countries should continue to be monitored. Prescription registries provide a wealth of publicly available data that can be used to monitor and to guide prescribing policies in a more knowledge-based direction.</jats:p></jats:sec>

The Surgeon's Role in the Opioid Crisis: A Narrative Review and Call to Action

“…Similar trends have emerged in Canada (3), parts of Central and Western Europe (1), and Australia (4,5). Even in Norway and Sweden, where the overall prevalence of prescription opioid use has been comparatively stable over the last decade, there has been an increase in both the availability of the strong opioid oxycodone and oxycodone related deaths (6,7).…”

Trends in opioid prescribing in Estonia (2011‐2017)

“…Increasing codeine sales have received attention in Europe in relation to abuse affecting diverse groups of patients, from children to older people and among all social classes . Decreasing morphine use in parallel with the sharply increasing use of oxycodone is described in Scandinavian countries, the United Kingdom, Australia, and the United States . Escalating use of fentanyl for the treatment of chronic noncancer pain has also been documented elsewhere (Australia, Scandinavian countries).…”

The association between initial opioid type and long-term opioid use after hip fracture surgery in elderly opioid-naïve patients

“…Although evidence supporting the choice of one specific opioid type over another is lacking, recommendations exist regarding considerations of specific patient factors [9]. There has been a global shift in patterns of prescription opioid use, specifically the types of opioid prescribed [10][11][12], but the total number of opioid users in Denmark has stabilized from 2011 to 2012 up to 2017 [10,12]. A study across multiple pain etiologies, including surgery, determined that higher doses, longer durations, slow-release formulations and prescribing of tramadol at initiation were associated with long-term opioid use [13].…”