To which extent does incident and persistent use of weak opioids predict problematic opioid use?
-
S. Skurtveit
Background
A high consumption of weak opioids may contribute to prescription abuse of opioids, but the risk of development of problematic opioid use in patients starting opioid therapy is not established.
Objective
To investigate the prevalence of prescription patterns indicating problematic opioid use in a cohort of patients starting therapy with the weak opioids.
Materials and methods
Prescription data were drawn from the nationwide Norwegian Prescription Database. The study population (N= 243,228) consisted of all adult patients in Norway receiving one or more dispensions of the weak opioids codeine and tramadol in 2005, who had not received any opioid in 2004. This cohort was followed until December 2008 and their dispensions of opioids and benzodiazepines during the study period were investigated, with focus on the patients who received opioid dispensions each year during the study period. Problematic opioid use patients had to meet the following three criteria: dispensed more than 365 defined daily doses (DDDs) of opioids, receiving prescriptions from more than three doctors and were dispensed more than 100 DDDs of benzodiazepines during 2008.
Results
In 2005 there were 243,228 new users of weak opioids (216,902 of codeine, 26,326 of tramadol) representing 5% of the Norwegian population. 17,005 (7%) received opioids every year during the study period 2005–2008. About 4% (N = 669) of the subjects who received opioids every year were dispensed >365 DDDs opioids in 2008 and 31% (N = 5328) co-medicated with benzodiazepines. 182 subjects were classified as possible problematic opioid users.
Conclusion
Among new users of weak opioids in 2005, 7% continued to receive one or more prescription of weak opioids the three following years. However, only 0.07% of the cohort starting weak opioids in 2005 developed a prescription pattern during four years of follow-up which indicates problematic opioid use.
© 2010 Scandinavian Association for the Study of Pain
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