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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

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Volume 19, Issue 2


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


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.


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.


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%).


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


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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.

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

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