Changes in opioid prescribing behaviour in Denmark, Sweden and Norway - 2006-2014

Changes in opioid prescribing behaviour in Denmark, Sweden and Norway - 2006-2014 Abstracts / Scandinavian Journal of Pain 12 (2016) 117–124organs are restored back to a physiological non-inflammatoryhomeostasis in order to prevent tissue degradation and pain.Opioid usage in Denmark, Norway and Sweden– 2006–2014 and regulatory factors in thesociety that might influence ithttp://dx.doi.org/10.1016/j.sjpain.2016.05.013Peter Heine Joergensen a,b,∗ , Lene Jarlbaek a,bChanges in opioid prescribing behaviour inDenmark, Sweden and Norway – 2006–2014L. Jarlbaek a,∗ , P. Joergensen baREHPA, The Danish Knowledge Centre forRehabilitation and Palliative Care, National Instituteof Public Health, University of Southern Denmark,Nyborg, Denmarkb Clinical Social Medicine and Rehabilitation, Centerfor Public Health and Quality Improvement, CentralRegion, Aarhus, DenmarkE-mail address: ljarlbaek@sdu.dk (L. Jarlbaek).Aims: A country’s use of opioids is frequently debated in thepublic, usually based on rough figures from prescription databases made for consumption registration purposes. However, thesedatabases hold much more detailed information that can be processed to increase knowledge and insight into nationally opioidprescribing-behaviour. This study aims to provide a more detailedpicture of opioid prescribing and its changes in Denmark, Swedenand Norway during 2006–2014.Methods: Data on opioid-use (ATC; N02A) were downloadedfrom each country’s publically assessable prescription-databases.Consumption-data were converted from defined daily doses(DDDs) to mg oral morphine equivalents (omeqs). Changes inchoice of opioid-types, use and number of users were presentedusing descriptive statistics and compared.Results: Opioid users: During the whole period, Norway had thehighest, and Denmark the lowest, number of opioid users/1000inhabitants. In 2006, Norway, Sweden and Denmark had 98, 79,66 users/1000 inhabitants. In 2014 the numbers were 105, 78,75 users/1000 inhabitants, respectively. Opioid use/user: Duringthe whole period, Norway had the lowest, and Denmark thehighest use/user. In 2006, the mean use/user was 1979, 3615,6025 mg omeq/user in Norway, Sweden and Denmark respectively.In 2014 the corresponding use was 2426, 3473, 6361 mg omeq/user.The preferred choices of opioid-types changed during the periodfor all three countries. The balance between use of weak or strongopioids showed more prominent changes for Norway and Swedencompared to Denmark.Conclusions: Three nations, closely related in culture and geographically, showed significant differences and changes in opioidprescribing behaviour. This knowledge can easily be overlookedusing the traditional way of presenting opioid consumption statistics. More detailed and clinically relevant presentation can increasethe knowledge of doctors’ opioid prescribing behaviour, that canbe related to changes in the society or health care system, likedemography, legislation and guidelines from authorities.http://dx.doi.org/10.1016/j.sjpain.2016.05.014121aDepartment of Clinical Social Medicine andRehabilitation, Center for Public Health and QualityImprovement, Central Region, Aarhus, Denmarkb Institute of Public Health, University of SouthernDenmark, Odense, DenmarkE-mail address: Heine@dadlnet.dk (P.H. Joergensen).Aims: To relate changes in the number of opioid users inDenmark, Norway and Sweden during 2006–2014 to changes innational regulatory and economic incentive factors.Methods: The material consists of data drawn from the nationalprescription databases in Denmark, Norway and Sweden. Data onthe number of opioid users per 1000 inhabitants were collectedfor all ages, both sexes and for the period 2006–2014. Concomitantchanges in regulatory or economic incentives were identified andrelated to the drug statistics.Results: For all opioids in the period 2006–2014 Denmark hadthe lowest number of users but the largest increase in users. Norwayhad the highest number of users but a lower increase. The numberof users in Sweden was very stable showing no change in numberof users.The number of morphine users in Denmark increased from 2009to 2014. The number of users of oxycodone decreased from 2010 to2014. The Danish health authorities recommended using morphineas first drug of choice in 2010 and warned about potential drugdependency of oxycodone in 2011.In Sweden the number of users of oxycodone increased overthe period with the largest increase from 2012 to 2013. The number af tramadol users decreased from 2011. Prior to these changestramadol was declared to be classified as an addictive drug 2011.Conclusions: Changes in the countries’ opioid use appeared inthe public prescription-databases in a timely manner after introduction of national recommendations not to use oxycodone andprefer morphine as first choice, or classify tramadol as an addictivedrug. National drug statistics show the end-result of the doctors’prescribing behavior and the population’s use of opioids. Thoroughinvestigation of prescription-data can help to detect and explain theinterplay between culture, society and medical reasons for prescribing opioids.http://dx.doi.org/10.1016/j.sjpain.2016.05.015 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Scandinavian Journal of Pain de Gruyter

Changes in opioid prescribing behaviour in Denmark, Sweden and Norway - 2006-2014

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de Gruyter
Copyright
© 2016 Scandinavian Association for the Study of Pain
ISSN
1877-8860
eISSN
1877-8879
D.O.I.
10.1016/j.sjpain.2016.05.014
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Abstract

Abstracts / Scandinavian Journal of Pain 12 (2016) 117–124organs are restored back to a physiological non-inflammatoryhomeostasis in order to prevent tissue degradation and pain.Opioid usage in Denmark, Norway and Sweden– 2006–2014 and regulatory factors in thesociety that might influence ithttp://dx.doi.org/10.1016/j.sjpain.2016.05.013Peter Heine Joergensen a,b,∗ , Lene Jarlbaek a,bChanges in opioid prescribing behaviour inDenmark, Sweden and Norway – 2006–2014L. Jarlbaek a,∗ , P. Joergensen baREHPA, The Danish Knowledge Centre forRehabilitation and Palliative Care, National Instituteof Public Health, University of Southern Denmark,Nyborg, Denmarkb Clinical Social Medicine and Rehabilitation, Centerfor Public Health and Quality Improvement, CentralRegion, Aarhus, DenmarkE-mail address: ljarlbaek@sdu.dk (L. Jarlbaek).Aims: A country’s use of opioids is frequently debated in thepublic, usually based on rough figures from prescription databases made for consumption registration purposes. However, thesedatabases hold much more detailed information that can be processed to increase knowledge and insight into nationally opioidprescribing-behaviour. This study aims to provide a more detailedpicture of opioid prescribing and its changes in Denmark, Swedenand Norway during 2006–2014.Methods: Data on opioid-use (ATC; N02A) were downloadedfrom each country’s publically assessable prescription-databases.Consumption-data were converted from defined daily doses(DDDs) to mg oral morphine equivalents (omeqs). Changes inchoice of opioid-types, use and number of users were presentedusing descriptive statistics and compared.Results: Opioid users: During the whole period, Norway had thehighest, and Denmark the lowest, number of opioid users/1000inhabitants. In 2006, Norway, Sweden and Denmark had 98, 79,66 users/1000 inhabitants. In 2014 the numbers were 105, 78,75 users/1000 inhabitants, respectively. Opioid use/user: Duringthe whole period, Norway had the lowest, and Denmark thehighest use/user. In 2006, the mean use/user was 1979, 3615,6025 mg omeq/user in Norway, Sweden and Denmark respectively.In 2014 the corresponding use was 2426, 3473, 6361 mg omeq/user.The preferred choices of opioid-types changed during the periodfor all three countries. The balance between use of weak or strongopioids showed more prominent changes for Norway and Swedencompared to Denmark.Conclusions: Three nations, closely related in culture and geographically, showed significant differences and changes in opioidprescribing behaviour. This knowledge can easily be overlookedusing the traditional way of presenting opioid consumption statistics. More detailed and clinically relevant presentation can increasethe knowledge of doctors’ opioid prescribing behaviour, that canbe related to changes in the society or health care system, likedemography, legislation and guidelines from authorities.http://dx.doi.org/10.1016/j.sjpain.2016.05.014121aDepartment of Clinical Social Medicine andRehabilitation, Center for Public Health and QualityImprovement, Central Region, Aarhus, Denmarkb Institute of Public Health, University of SouthernDenmark, Odense, DenmarkE-mail address: Heine@dadlnet.dk (P.H. Joergensen).Aims: To relate changes in the number of opioid users inDenmark, Norway and Sweden during 2006–2014 to changes innational regulatory and economic incentive factors.Methods: The material consists of data drawn from the nationalprescription databases in Denmark, Norway and Sweden. Data onthe number of opioid users per 1000 inhabitants were collectedfor all ages, both sexes and for the period 2006–2014. Concomitantchanges in regulatory or economic incentives were identified andrelated to the drug statistics.Results: For all opioids in the period 2006–2014 Denmark hadthe lowest number of users but the largest increase in users. Norwayhad the highest number of users but a lower increase. The numberof users in Sweden was very stable showing no change in numberof users.The number of morphine users in Denmark increased from 2009to 2014. The number of users of oxycodone decreased from 2010 to2014. The Danish health authorities recommended using morphineas first drug of choice in 2010 and warned about potential drugdependency of oxycodone in 2011.In Sweden the number of users of oxycodone increased overthe period with the largest increase from 2012 to 2013. The number af tramadol users decreased from 2011. Prior to these changestramadol was declared to be classified as an addictive drug 2011.Conclusions: Changes in the countries’ opioid use appeared inthe public prescription-databases in a timely manner after introduction of national recommendations not to use oxycodone andprefer morphine as first choice, or classify tramadol as an addictivedrug. National drug statistics show the end-result of the doctors’prescribing behavior and the population’s use of opioids. Thoroughinvestigation of prescription-data can help to detect and explain theinterplay between culture, society and medical reasons for prescribing opioids.http://dx.doi.org/10.1016/j.sjpain.2016.05.015

Journal

Scandinavian Journal of Painde Gruyter

Published: Jul 1, 2016

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