Secular Trends of Dispensed Opioid Prescriptions in Catalonia, Spain, 2007-19: A Population-based Cohort Study of over 5 Million Individuals

Saturday, August 27, 2022

8:30 AM – 8:45 AM CEST

Location: Congress Hall D5

Publication Number: 128

Background: Although opioid use is increasing in Northern and Central Europe, there is a scarcity of data regarding Southern European countries.

Objectives: This study aims to characterize the long-term trends in dispensed opioid prescriptions in Catalonia (Spain).

Methods: This population-based cohort study included all individuals aged 18 years or older, registered in the Information System for Research in Primary Care (SIDIAP), which covers >75% of the population in Catalonia, Spain, from January 1, 2007, to December 31, 2019. The exposures were all commercialized opioids and their combinations (ATC-codes): codeine, tramadol, oxycodone, tapentadol, fentanyl, morphine, and other opioids (dihydrocodeine, hydromorphone, dextropropoxyphene, buprenorphine, pethidine, pentazocine). The main outcomes were the annual figures per 1,000 individuals of (1) opioid users, (2) dispensations, and (3) oral morphine milligram equivalents (MME). Results were stratified separately by opioid types, age (five-year age groups), sex (male or female), living area (rural or urban), and socioeconomic status (from least, U1, to most deprived, U5). The overall trends were quantified using the percentage change (PC) between 2007 and 2019.

Results: From 2007 to 2019, the number of opioid users, dispensations and MME per 1000 individuals increased 12% (PC: 95% CI 11.9% to 12.3%), 105% (83% to 126%) and 339% (289% to 390%), respectively. Opioid indications (i.e cancer and non-cancer pain diagnosis) were also analysed. Tramadol represented the majority of opioid use in 2019 (61%, 59%, and 54% of opioid users, dispensations, and total MME, respectively). Individuals aged 80 years or over reported the sharpest increase in all three main outcomes: opioid users (PC:162%), dispensations (PC:424%), and MME (PC:830%). Strong opioids were increasingly prescribed and dispensed for non-cancer pains over the years.

Conclusions: Despite the modest increase of opioid users, opioid dispensations and MME increased substantially, particularly among the older population. In addition, strong opioids were incrementally indicated for non-cancer pains over the years. These findings suggest an emerging opioid health care problem. The transition of opioid prescriptions from intermittent to chronic and from weak to strong calls for more rigorous opioid stewardship.

Presenting Author(s)

Junqing Xie

CSM, NDORMS, University of Oxford
Oxford, Oxfordshire, United Kingdom

Slides

Co-Author(s)

VS

Victoria Y. Strauss

Dr
Boehringer Ingelheim Pharma GmbH & Co. KG
Ingelheim am Rhein, Germany
GC

Gary S Collins

Professor
Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK, England, United Kingdom
SK

Sara Khalid

CSM, NDORMS, University of Oxford
Oxford, Oxfordshire, United Kingdom
AD

Antonella Delmestri, PhD

SENIOR HEALTH DATA SCIENTIST
Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine - Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Windmill Road, Oxford, England, United Kingdom
AT

Aleksandra Turkiewicz

4. Clinical Epidemiology Unit, Orthopaedics, Clinical Sciences, Lund, Lund University, Lund, Sweden, Sweden
mE

martin Englund

4. Clinical Epidemiology Unit, Orthopaedics, Clinical Sciences, Lund, Lund University, Lund, Sweden, Sweden
Mina Tadrous, PharmD, PhD, MS

Assistant Professor
University of Toronto
Toronto, Ontario, Canada
CR

Carlen Reyes

Institut Universitari d�Investigaci� en Atenci� Prim�ria Jordi Gol
IDIAP Jordi Gol
BARCELONA, Barcelona, Spain
Daniel Prieto-Alhambra, MD, MSc, PhD, FISPE

Professor of Pharmaco- and Device Epidemiology
CSM, NDORMS, University of Oxford
University of Oxford
Oxford, United Kingdom