(67) Opioid Utilization Profile in Brazilian Federal Hospitals

Publication Number: 1112

Background: Global consumption and deaths related to inappropriate opioid use have increased. While countries in the Northern Hemisphere debate about an opioid epidemic, countries in the South, such as Brazil, still need studies to measure differences in their use and investigate how inpatient consumption is contributing to this increase.

Objectives: To analyze public purchases of opioids in Brazilian federal hospitals.

Methods: A longitudinal study of consumption was performed, using purchases as a proxy for consumption. Opioids were selected based on national and international consumption trends and relevance of use, from 2010 to 2019, in Brazilian federal hospitals.The bidding data was collected from the Integrated System of General Services Administration (SIASG) and hospital data from the National Registry of Health Establishments (CNES). Hospitals were stratified by region, number of beds, complexity and service characteristics. Consumption was expressed in mg / 100 beds (since not all opioids had DDD or S-DDD and occupancy rates were not available for calculating bed-days).

Results: The general consumption of opioids in 85 federal hospitals increased 159% over the ten-year period, from 3.4 million mg / 100 beds in 2010 to 8.8 in 2019. In 2019, 25 hospitals in the Southeast region consumed 3.5 times the amount of opioids compared to the other four Brazilian regions.
Most large, medium/high complexity federal hospitals were mainly linked to the Ministry of Education (MEC), but consumption was led by hospitals with the same profile as the Ministry of Health (MS). Except in 2015, in which Ministry of Defense (MD) hospitals, mostly small and low/medium complexity, which serve exclusively military personnel, recorded tramadol consumption higher than the largest federal hospitals in the country (69,632 DDD/100 beds), which is equivalent to 5 times the amount consumed by MEC hospitals and 1.7 times the MS hospitals. Tramadol and morphine were the most consumed opioids, corresponding to more than 95% of purchases during the study period.

Conclusions: Despite the limitations regarding the availability of data for calculating the nDDD / 100 bed-days, there was a substantial increase in consumption and regional disparities in federal hospitals. Other studies involving data on consumption, accompanied by dispensing data, prescription and other sources of information, such as hospital stay, pain assessment during hospitalization, can help clarify the quality of pain treatment. Since federal hospitals concentrate a considerable amount of highly complex care in the public sector, measuring opioid consumption by these facilities is important to keep up with general trends in Brazil.