Background & Aims
Background: IASP statement on opioids in modern pharmacological treatment of pain recommends opioids in long-term pain only in limited doses, under limited time and in very well selected group of patients mostly due to the lack of effect and the risk for the complications.(1) Regular follow up of opioid prescription has become a routine in many countries for many health providers since the opioid pandemic(2). However, prescription of other pharmacologic groups remains in the shadow of this problem despite of questionable efficacy of many drugs in chronic pain and comorbidity such as sleeping disorders(3, 4).
Aim: The aim of this study was to compare prescription and costs of opioids versus other analgesics during last four years in tertiary pain center in Sweden.
Methods
Data were extracted from E-health agency in Sweden through SAS Visual Analytics.
The variables were: DDD (defined daily doses) of the drugs, total costs of expedited drugs without VAT (AUP), total costs of drug subvention per patient and number of patients receiving prescription per drug as well as number of patients referred to the clinic and number of new visits to the clinic during 2020-2023. Data were analyzed with descriptive statistics.
Results
Results: The total number of new patients treated at the clinic per year has increased since the covid-19 pandemic (2020: 954, 2023: 1451) (+52%). Number of DDD of all drugs prescribed at the clinic decreased between 2019-2023 from 556 927 to 313 435, (-44%). The number of DDD opioids prescribed and retrieved from the pharmacy decreased from 19157 in 202 to 5241 in 2023 (-73%). A decrease of prescribed DDD of all other analgesics, i e gabapentinoids (-17%), NSAIDs (-47%), paracetamol (-32%) and antidepressants (-47%) were observed as well. A decrease in costs of analgesics ( 2020 4,141 mil SEK, 2023 2,820 mil SEK, -38%) followed the trend in DDD. Costs of opioids decreased with 40%; -1,112 mil SEK) On the other hand, increased costs of prescription of suvorexant (+1219%! +2,58 mil SEK) despite of decrease of costs other sleep medicine (-84%, -0,4 mil SEK)) was noticed as well.
Conclusions
Post-pandemic decrease of prescription of opioids is accompanied by parallel decrease of prescription of all analgesics despite an increasing number of patients being treated at the clinic. However, the decreased prescription of opioids is most substantial and is a major part of the total decrease in pharmacologic costs. It remains unclear if and how this trend affects quality of life and pain suffering of the patients and if the costs of novel treatment of sleeping disorders are defensible.
References
1.Ballantyne JCB, S.; Blyth, F.;Cardosa, M.; Finley, A.; Furlan, A.; Garcia, J.B.; Goh, C.R.; Kalso, E.; Sommer, C.;Stannard,C. IASP Statement on Opioids [webbpage]. www.iasp-pain.org: IASP; 2018 [Available from: https://www.iasp-pain.org/Advocacy/OpioidPositionStatement.
2.Zeitouny S, McGrail K, Tadrous M, Wong ST, Cheng L, Law M. Impact of the COVID-19 pandemic on prescription drug use and costs in British Columbia: a retrospective interrupted time series study. BMJ Open. 2024;14(1):e070031.
3.De Crescenzo F, D’Alo GL, Ostinelli EG, Ciabattini M, Di Franco V, Watanabe N, et al. Comparative effects of pharmacological interventions for the acute and long-term management of insomnia disorder in adults: a systematic review and network meta-analysis. Lancet. 2022;400(10347):170-84.
4.Sindrup SH, Otto M, Finnerup NB, Jensen TS. Antidepressants in the treatment of neuropathic pain. Basic Clin Pharmacol Toxicol. 2005;96(6):399-409.
Presenting Author
Lenka Katila
Poster Authors
Topics
- Treatment/Management: Pharmacology: Opioid