Jump to ContentJump to Main Navigation
Show Summary Details
More options …

Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Breivik, Harald


CiteScore 2018: 0.85

SCImago Journal Rank (SJR) 2018: 0.494
Source Normalized Impact per Paper (SNIP) 2018: 0.427

Online
ISSN
1877-8879
See all formats and pricing
More options …
Volume 19, Issue 2

Issues

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

Ashley Elizabeth Muller
  • Corresponding author
  • Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Pb 1039 Blindern, 0316 Oslo, Norway
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Thomas Clausen
  • Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Per Sjøgren
  • Department of Oncology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
  • Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Ingvild Odsbu / Svetlana Skurtveit
  • Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  • Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2019-01-24 | DOI: https://doi.org/10.1515/sjpain-2018-0307

Abstract

Background and aims

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.

Methods

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.

Results

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%).

Conclusions

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.

Keywords: opioids; chronic non-cancer pain; prescription registry; Nordic; oxycodone; tramadol

References

  • [1]

    Krebs EE, Gravely A, Nugent S, Jensen AC, DeRonne B, Goldsmith ES, Kroenke K, Bair MJ, Noorbaloochi S. Effect of opioid vs. nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: the SPACE randomized clinical trial. JAMA 2018;319:872–82.CrossrefWeb of SciencePubMedGoogle Scholar

  • [2]

    Chou R, Turner JA, Devine EB, Hansen RN, Sullivan SD, Blazina I, Dana T, Bougatsos C, Deyo RA. The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a National Institutes of Health Pathways to Prevention Workshop. Ann Intern Med 2015;162:276–86.Web of ScienceCrossrefPubMedGoogle Scholar

  • [3]

    Brat GA, Agniel D, Beam A, Yorkgitis B, Bicket M, Homer M, Fox KP, Knecht DB, McMahill-Walraven CN, Palmer N, Kohane I. Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: retrospective cohort study. BMJ 2018;360:j5790.Web of SciencePubMedGoogle Scholar

  • [4]

    Dunn KE, Brooner RK, Clark MR. Severity and interference of chronic pain in methadone-maintained outpatients. Pain Med 2014;15:1540–8.CrossrefWeb of SciencePubMedGoogle Scholar

  • [5]

    Seth P, Rudd RA, Noonan RK, Haegerich TM. Quantifying the epidemic of prescription opioid overdose deaths. Am J Public Health 2018;108:500–2.Web of ScienceCrossrefPubMedGoogle Scholar

  • [6]

    Hauser W, Schug S, Furlan AD. The opioid epidemic and national guidelines for opioid therapy for chronic noncancer pain: a perspective from different continents. Pain Rep 2017;2:e599.CrossrefGoogle Scholar

  • [7]

    Hamunen K, Laitinen-Parkkonen P, Paakkari P, Breivik H, Gordh T, Jensen NH, Kalso E. What do different databases tell about the use of opioids in seven European countries in 2002? Eur J Pain 2008;12:705–15.CrossrefWeb of SciencePubMedGoogle Scholar

  • [8]

    Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain 2006;10:287–333.CrossrefPubMedGoogle Scholar

  • [9]

    Danish Health Authority. Kortlægning af opioidforbruget i Danmark: MED FOKUS PÅ PATIENTER MED KRONISKE NON-MALIGNE SMERTER. Copenhagen: Danish Health Authority, 2016 [86]. Available at: https://www.sst.dk/da/udgivelser/2016/∼/media/69913B827BAA4850A9A70E0CF76CB305.ashx.

  • [10]

    Skurtveit S, Sakshaug S, Hjellvik V, Berg C, Handal M. Bruk av vanedannende legemidler i Norge 2005 – 2013 Basert på data fra Reseptregisteret. Oslo: Norwegian Institute of Public Health, 2014 [72]. Available at: https://www.fhi.no/publ/2014/bruk-av-vanedannende-legemidler-i-n/.

  • [11]

    Gustavsson A, Bjorkman J, Ljungcrantz C, Rhodin A, Rivano-Fischer M, Sjolund KF, Mannheimer C. Pharmaceutical treatment patterns for patients with a diagnosis related to chronic pain initiating a slow-release strong opioid treatment in Sweden. Pain 2012;153:2325–31.Web of SciencePubMedCrossrefGoogle Scholar

  • [12]

    Elzey MJ, Barden SM, Edwards ES. Patient characteristics and outcomes in unintentional, non-fatal prescription opioid overdoses: a systematic review. Pain Physician 2016;19: 215–28.PubMedGoogle Scholar

  • [13]

    Norwegian Directorate of Health. Nasjonal faglig veileder for bruk av opioider – ved langvarige ikke-kreftrelaterte smerter 2014 [updated 14.9.2016]. Available at: https://helsedirektoratet.no/retningslinjer/opioider.

  • [14]

    Swedish Medical Products Agency. Användning av opioider vid långvarig icke-cancerrelaterad smärta – Rekommendationer 2002 [1]. Available at: https://lakemedelsverket.se/upload/halso-och-sjukvard/behandlingsrekommendationer/opioider_rek_bokm.pdf.

  • [15]

    Danish Medicines Agency. Nyt fra Lægemiddelstyrelsen Copenhagen: Danish Medicines Agency, 2017 [updated 9.2017. Nr 1, årgang]. Available at: https://laegemiddelstyrelsen.dk/da/nyheder/2017/nyt-fra-laegemiddelstyrelsen/∼/media/37BA84EB45434059B5C95288AC5CFE4B.ashx.

  • [16]

    WHO. ATC Classification Index with DDDs 2018. WHO Collaborating Centre for Drug Statistics Methodology. Oslo, Norway: Norwegian Institute of Public Health, 2017.Google Scholar

  • [17]

    Mahic M, Fredheim OM, Borchgrevink PC, Skurtveit S. Use of prescribed opioids by children and adolescents: differences between Denmark, Norway and Sweden. Eur J Pain 2015;19:1095–100.Web of ScienceCrossrefPubMedGoogle Scholar

  • [18]

    Bäckryd E, Heilig M, Hoffmann M. Dynamiken i förskrivningen av opioider i Sverige 2000–2015. Läkartidningen 2017;114:6.Google Scholar

  • [19]

    Stubhaug A, Grimstad J, Breivik H. Lack of analgesic effect of 50 and 100 mg oral tramadol after orthopaedic surgery: a randomized, double-blind, placebo and standard active drug comparison. Pain 1995;62:111–8.PubMedCrossrefGoogle Scholar

  • [20]

    Myhr K. Tramadol – et problematisk legemiddel ved langtidsbruk: RELIS, 2014 [updated 14.10.2014]. Available at: https://relis.no/Aktuelt/Arkiv/2014/Tramadol_et_problematisk_legemiddel_ved_langtidsbruk/.

  • [21]

    Olsson MO, Ojehagen A, Bradvik L, Kronstrand R, Hakansson A. High rates of tramadol use among treatment-seeking adolescents in Malmo, Sweden: a study of hair analysis of nonmedical prescription opioid use. J Addict 2017;2017:6716929.PubMedGoogle Scholar

  • [22]

    Birke H, Ekholm O, Sjogren P, Fredheim O, Clausen T, Skurtveit S. Tramadol use in Norway: a register-based population study. Pharmacoepidemiol Drug Saf 2018:1–8. https://doi.org/10.1002/pds.4626.

  • [23]

    Dhalla IA, Mamdani MM, Sivilotti MLA, Kopp A, Qureshi O, Juurlink DN. Prescribing of opioid analgesics and related mortality before and after the introduction of long-acting oxycodone. CMAJ 2009;181:891–6.CrossrefPubMedGoogle Scholar

  • [24]

    Leifman H. Drug-Related Deaths in Sweden – Estimations of Trends, Effects of Changes in Recording Practices and Studies of Drug Patterns. Stockholm: Swedish Council for Information on Alcohol and Other Drugs, 2016. Available at: https://can.se/contentassets/7bab9dbeec3a43269139af78e5653bbc/drug-related-deaths-in-sweden.pdf.

  • [25]

    Edvardsen HM, Rogde S, Clausen T, Vindenes V. GHB, fentanyl og oksykodonrel dødsfall. Oslo: Oslo University Hospital and the Norwegian Centre for Addiction Research, 2018.Google Scholar

  • [26]

    Mikkelsen CM, Andersen SE. Morphine: oxycodone interventions in Denmark. Eur J Hosp Pharm 2012;19:545–6.CrossrefGoogle Scholar

  • [27]

    Joergensen PH, Jarlbaek L. Opioid usage in Denmark, Norway and Sweden – 2006–2014 and regulatory factors in the society that might influence it. Scand J Pain 2016;12:121.CrossrefGoogle Scholar

  • [28]

    Winstock AR, Borschmann R, Bell J. The non-medical use of tramadol in the UK: findings from a large community sample. Int J Clin Pract 2014;68:1147–51.Web of ScienceCrossrefPubMedGoogle Scholar

  • [29]

    Christup L, Sædder E. Potentielle farmakologiske konsekvenser som følge af udviklingen i forbruget af opioider i Danmark. Ugeskr Laeger 2017;179:4.Google Scholar

  • [30]

    Birke H, Ekholm O, Sjogren P, Kurita GP, Hojsted J. Long-term opioid therapy in Denmark: a disappointing journey. Eur J Pain 2017;21:1516–27.Web of ScienceCrossrefGoogle Scholar

  • [31]

    Eriksen J, Sjogren P, Bruera E, Ekholm O, Rasmussen NK. Critical issues on opioids in chronic non-cancer pain: an epidemiological study. Pain 2006;125:172–9.CrossrefPubMedGoogle Scholar

  • [32]

    Abs R, Verhelst J, Maeyaert J, Van Buyten J-P, Opsomer F, Adriaensen H, Verlooy J, Van Havenbergh T, Smet M, Van Acker K. Endocrine consequences of long-term intrathecal administration of opioids. J Clin Endocrinol Metab 2000;85:2215–22.CrossrefPubMedGoogle Scholar

  • [33]

    Angst M, Clark J. Opioid-induced hyperalgesia: a qualitative systematic review. Anesthesiology 2006;104:17.Google Scholar

  • [34]

    Baldini A, Von Korff M, Lin EHB. A review of potential adverse effects of long-term opioid therapy: a practitioner’s guide. Prim Care Companion CNS Disord 2012;14:PCC.11m01326.PubMedGoogle Scholar

  • [35]

    Benyamin R, Trescot AM, Datta S, Buenaventura R, Adlaka R, Sehgal N, Glaser SE, Vallejo R. Opioid complications and side effects. Pain Physician 2008;11(2 Suppl):S105–20.PubMedGoogle Scholar

  • [36]

    Rhodin A, Stridsberg M, Gordh T. Opioid endocrinopathy: a clinical problem in patients with chronic pain and long-term oral opioid treatment. Clin J Pain 2010;26:374–80.Web of SciencePubMedCrossrefGoogle Scholar

  • [37]

    Birke H, Ekholm O, Hojsted J, Sjogren P, Kurita GP. Chronic pain, opioid therapy, sexual desire, and satisfaction in sexual life: a population-based survey. Pain Med 2018. https://doi.org/10.1093/pm/pny122.PubMed

About the article

Received: 2018-09-05

Revised: 2018-12-14

Accepted: 2018-12-18

Published Online: 2019-01-24

Published in Print: 2019-04-24


Authors’ statements

Research funding: The authors state no funding was involved. IO is employed at the Centre for Pharmacoepidemiology, Karolinska Institutet, which receives grants from several entities (pharmaceutical companies, regulatory authorities and contract research organizations) for performance of drug safety and drug utilization studies. These entities had no role in the data collection or analysis, neither were they involved in the interpretation of results, writing, revision, or approval of the manuscript.

Conflict of interest: The authors state no conflict of interest.

Informed consent: No informed consent was necessary.

Ethical approval: Not applicable.


Citation Information: Scandinavian Journal of Pain, Volume 19, Issue 2, Pages 345–353, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1515/sjpain-2018-0307.

Export Citation

©2019 Scandinavian Association for the Study of Pain. Published by Walter de Gruyter GmbH, Berlin/Boston. All rights reserved..Get Permission

Comments (0)

Please log in or register to comment.
Log in