(94) Opioid Prescriber Responsibility: A Danish Drug Utilization Study

Publication Number: 425

Background: New guidelines and regulatory actions are continuously being developed to facilitate rational use of drugs. To support interventions, it is essential to have both updated and detailed data on the use of drugs, including which physicians are responsible for issuing prescriptions for the drugs in question.

Objectives: To support further activities in promoting the rational use of opioids, we aimed to describe changes in prescribers’ responsibility for opioid initiation and maintenance in Denmark.

Methods: We identified a random 20% sample of all Danes alive at any point between 2000 and 2020 and used the Danish National Prescription Registry to identify all prescriptions of opioids filled. We then described the distribution of prescribers responsible for opioid initiation and maintenance. The prescribers were divided into general practitioners, hospital prescribers, and other prescribers.

Results: Overall, general practitioners were responsible for most opioid initiation (75% during 2000-2020) and in particular opioid maintenance treatment (92%). However, while hospital prescribers initiated ≈20% of opioid treatments during 2001-2012, this increased to 36% in 2020. Similarly, hospital prescriber’s share of maintenance treatment increased from 5.9% during 2000-2012 to 12% in 2020. This change was particularly pronounced for morphine initiation (49% hospital prescribers in 2020 up from 38% during 2000-2010) and oxycodone initiation (77% up from 41%). Regarding choice of opioids, codeine use dropped markedly, particularly among hospital prescribers. Tramadol was consistently the most common first choice opioid in general practice (32% in 2020), whereas its use among hospital prescribers decreased (from 54% during 2000-2015 to 21% in 2020). Conversely, the proportion of treatment initiation by hospital prescribers comprised of morphine and oxycodone increased to 36% and 40% in 2020, respectively.

Conclusions: General practitioners prescribe most opioids in Denmark, however, hospital prescribers are increasingly responsible for opioid prescribing, in particular initiation of morphine and oxycodone. These data will be useful to support future initiatives to further ensure rational use of opioids.