Trends in strong opioid prescription for cancer patients in Japan from 2010 to 2019: an analysis with large medical claims data

Abstract

Background Consumption of opioids, essential drugs for pain relief, has seen rapid growth worldwide. In Japan, where total opioid consumption still remains low among developed countries, little is known about trends in the clinical patterns of opioids in terminally ill cancer patients. Methods Patients who died of cancer from 2010 to 2019 were included in this study. Morphine, oxycodone, fentanyl, tapentadol, methadone and hydromorphone were examined as opioids for cancer pain. We calculated the prevalence of prescribed opioids prior to death by year and age group and the average opioid dose 30 days before death. Results The total number of patients was 221 598. We found that the prescription prevalence of opioids increased from 60.8 to 65.9% (5.1%). Morphine was most prescribed in 2010 but had decreased prevalence (−9.0%) during the 10-year period. Oxycodone had the highest increase in prescription prevalence (13.7%), and fentanyl prevalence decreased (−4.9%). In the subgroup comparison, the prescription prevalence of opioids in the elderly was lower than that in the younger group; however, the increasing trend in the elderly was greater than that in the younger group. The percentage of patients prescribed low-dose opioids (<60 mg/day) during the 30 days before death increased by 4.9% and was the highest throughout the study period. Conclusion The prevalence of opioid prescriptions for terminally ill cancer patients has increased from 2010 to 2019 in Japan. The opioid-specific trends were similar to the global trend but differed by palliative care specialty.

The trend of opioid prescriptions among cancer patients in a tertiary hospital: A multimethod quantitative study

“…In terms of age, MEDD was highest in young adult patients, under 42 years of age. Previous studies have reported a decrease in opioid use in older patients (15,25). However, the association between age and pain perception remains uncertain.…”

“…Additionally, to promote the appropriate use of opioids for pain control, it is important to assess the factors affecting opioid prescriptions in cancer patients. Various studies have shown that certain factors, including older age, may limit the use of opioids for pain control ( 9 , 15 ).…”

High prevalence of severe pain is associated with low opioid availability in patients with advanced cancer: Combined database study and nationwide questionnaire survey in Japan

“…The prescription doses of opioids for patients with end-stage cancer did not reach the ACM recommendation in this study. In addition, a recent study using another Japanese claim database reported that the daily opioid dose was less than 60 mg oral morphine equivalents in 30-40% of patients with end-stage cancer in the last 30 days before death [13]. It is possible that the opioid prescription dose is insu cient in this patient population, resulting in severe-tointolerable cancer-related pain in Japan.…”

Comparison of different sustained‐release opioids and acute respiratory conditions in patients with cancer and chronic kidney disease

“…1 In Japan as well, oxycodone is the most prescribed opioid and the number of prescriptions is increasing. 2 Notably, 50% of patients with cancer have decreased kidney function and have high mortality and hospitalization rates. 1,3 Serum levels of oxycodone and its active metabolite nor-oxycodone are higher in patients with chronic kidney disease (CKD) than in those without CKD.…”

“…In 2017, approximately 29 million adults in the United States received prescriptions for opioids, 25% of which were for oxycodone 1 . In Japan as well, oxycodone is the most prescribed opioid and the number of prescriptions is increasing 2 . Notably, 50% of patients with cancer have decreased kidney function and have high mortality and hospitalization rates 1,3 …”