Background & Aims
Opioids are central to the treatment of moderate to severe postoperative pain. However, the risks of opioid use challenge surgeons and physicians’ decisions on postoperative pain management (1). The prevalence of opioid use has remained stable in the Nordic countries over the recent years (2, 3), although some differences in total consumption, dispensed substances and intensity of use per patient has been reported (3, 4). The trends in overall postoperative opioid use in the Nordic setting has yet to be described. Due to this, the present study investigates trends in opioid use after surgery, including examination of short- and long-term use, distribution of depot formulations, and amount dispensed in Norway from 2011 to 2018.
Methods
We utilized nationwide health registries (The Norwegian Patient Registry; The Norwegian Prescription Database; The Cancer Registry of Norway) and obtained data on surgical procedures and dispensed opioids in the period 2010-19. Patients ? 15 years with an opioid dispensing within 2 weeks after surgery were included. Surgery was classified according to the NOMESCO system. Cancer and opioid maintenance therapy the year prior to surgery, and lost to follow-up the year after surgery, led to exclusion. Hamina and colleagues definition (3) of long-term opioid use (at least 2 opioid dispensings within two subsequent 90-day periods) was partly adopted. Different from Hamina et al. (3) we added an intensity requirement to the definition, to capture problematic opioid use (a minimum average use of 10 MME/day the first 90 days). We calculated the mean amount of index dispensed postoperative opioids and distribution of depot formulations, stratified on short- or long-term use, substance, and year.
Results
The study population consisted of 703 002 persons with postoperative opioid use (mean age: 49.4 years, females: 53.6%). Surgery in the locomotor system accounted for 43% of the surgeries. In 2011, 96% of index opioid dispensings were codeine-paracetamol or tramadol, decreasing to 88% in 2018. The prevalence of oxycodone as index opioid dispensing increased from 2.4% to 9.8% from 2011 to 2018. The treatment intensity, i.e., mean amount of the index opioid dispensings, decreased over the study period. For instance, long-term users were dispensed 669 MMEs and 17 DDDs in 2011 compared to 567 MMEs and 11 DDDs in 2018. Long-term users were dispensed about seven times the amount of opioids at the first dispensing after surgery compared to short-term users. Depot formulations constituted 4.7% in 2011 and 9% in 2018.
Conclusions
Between 2011 and 2018, postoperative index dispensings of codeine or tramadol decreased, while oxycodone increased. The treatment intensity of postoperative opioids decreased, while the utilization of depot formulations increased.
References
1. Breivik H, Collett B et al. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. European journal of pain (London, England) 2006; 10(4): 287-333.
2. Hamina A, Hjellvik V et al. Describing long-term opioid use utilizing Nordic prescription registers-A Norwegian example. Basic & clinical pharmacology & toxicology 2022; 130(4): 481-91.
3. Keto J, Heiskanen T et al. Opioid trends in Finland: a register-based nationwide follow-up study. Scientific reports 2022; 12(1): 7261.
4. Hamina A, Muller AE et al. Prescription opioids among older adults: ten years of data across five countries. BMC geriatrics 2022; 22(1): 429.
Presenting Author
Sara M. Vambheim
Poster Authors
Sara Vambheim
PhD
Department of pain management and research, Oslo university hospital, Norway
Lead Author
Topics
- Epidemiology