(124) Trends in Dispensing and Utilisation of Tapentadol in Australia

Sunday, August 28, 2022

8:00 AM – 1:45 PM CEST

Location: Hall C

Publication Number: 1169

Presenting Author(s)

Ximena Camacho
– Sydney, New South Wales, Australia

Co-Author(s)

Andrea Schaffer, MSc, MBiostat, PhD
– Epidemiologist, University of New South Wales, United Kingdom
Nicholas A. Buckley
– Biomedical Informatics and Digital Health, The University of Sydney, Australia
Nicole Pratt, FISPE
– University of South Australia, Adelaide, South Australia, Australia
David Henry
– Bond University, Australia
Sallie-Anne Pearson, PhD
– Director, Centre of Research Excellence in Medicines Intelligence, Centre for Big Data Research in Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia, New South Wales, Australia

Background: Tapentadol is a µ-opioid agonist, moderate noradrenaline reuptake inhibitor and very weak serotonin reuptake inhibitor. It is less potent than most strong opioids but toxicity is yet to be fully understood. The sustained-release formulation, indicated for relief of chronic moderate to severe pain, was listed for government subsidy in Australia in June 2014. Changes to prescribing policies to support safe and appropriate opioid use in Australia were introduced in June 2020; the Covid-19 pandemic also impacted prescribing behaviour. Although sales of tapentadol have increased since its introduction to market, long-term patterns of utilisation and the impact of these policy and practice changes have not been assessed.

Objectives: To estimate trends in utilisation and dispensing of publicly subsidized prescription tapentadol in Australia between 2014 and 2021.

Methods: We used a 10% sample of the Australian Pharmaceutical Benefits Scheme dispensing data from 1 June 2014 to 31 December 2021. We assessed annual prevalence and incidence rates, dispensing patterns and characteristics of tapentadol initiators.

Results: The number of monthly initiators increased steadily from September 2014 to a maximum of 1572 in November 2019, before decreasing by 31% to 1084 in December 2021. Total monthly dispensed prescriptions increased from June 2014 and plateaued from June 2020, coinciding with changes to opioid prescribing policies in Australia. The lowest strength formulations (50mg, 100mg) comprised nearly three quarters of all dispensed prescriptions. On average, fewer than 5% of dispensed prescriptions were for the strongest formulation (250mg). There were 69,795 tapentadol initiations between September 2014 and December 2020. The largest proportion of tapentadol initiations were among individuals aged 45-84 years (51,072; 73.2%) and among females (39,740; 56.9%). Despite the approved indication being for chronic pain and the supply covering two weeks at recommended doses, over half the patients (40,126; 57.5%) did not receive a second dispensing within 90 days of initiation.

Conclusions: The overall patterns of tapentadol dispensing align with that of other opioids, although the drivers of the decrease in tapentadol initiations are unclear. The timing coincides with the Covid-19 pandemic which saw markedly reduced rates of GP visits. A government announcement foreshadowing changes to opioid prescribing policies may have also been a factor. These preliminary analyses will form the basis of further investigations of safety outcomes.