Abstract
Over the past decade opioid use has risen globally. The causes and consequences of this increase, especially in Europe, are poorly understood. We conducted a population-based cohort study using national statistics on analgesics prescriptions, opioid poisoning hospital admissions and deaths in the Netherlands from 2013 to 2017. Pain prevalence and severity was determined by using results of 2014–2017 Health Interview Surveys. Between 2013 and 2017 the proportion of residents receiving opioid prescription rose from 4.9% to 6.0%, and the proportion of those receiving NSAIDs decreased from 15.5% to 13.7%. Self-reported pain prevalence and severity remained constant, as 44.7% of 5,119 respondents reported no pain-impeded activities-of-daily-living in 2014 (aRR, 1.00 [95% CI, 0.95–1.06] in 2017 vs 2014). Over the observation period, the incidence of opioid poisoning hospitalization and death increased from 8.6 to 12.9 per 100,000 inhabitants. The incidence of severe outcomes related to opioid use increased, as 3.9% of 1,343 hospitalized for opioid poisoning died in 2013 and 4.6% of 2,055 in 2017. We demonstrated that NSAIDs prescription decreased and opioid prescription increased in the Netherlands since 2013, without an increase in pain prevalence and severity. Consequently, the incidence of severe outcomes related to opioids increased.
Highlights
Over the past decade opioid use has risen globally
For the evaluation of analgesic prescription practice and consequences of changes thereof we studied 2 populations: the total Dutch population between 2013 and 2017, and the GE survey participants between 2014 and 2017
We previously reported an increase in opioid prescription and related fatalities in the Netherlands from 2013 to 20172
Summary
Over the past decade opioid use has risen globally. The causes and consequences of this increase, especially in Europe, are poorly understood. The incidence of severe outcomes related to opioid use increased, as 3.9% of 1,343 hospitalized for opioid poisoning died in 2013 and 4.6% of 2,055 in 2017. We demonstrated that NSAIDs prescription decreased and opioid prescription increased in the Netherlands since 2013, without an increase in pain prevalence and severity. Concurrently an increase in oxycodone use has been noted[9] It is unknown whether the increase in opioid prescription is paralleled by a similar decrease in NSAIDs prescriptions, which could offer an explanation of the opioid crisis. Studies from the United States have shown that wide-spread use of prescription opioids in the community preceded illegal opioid t rade[10, 11] The latter introduces an additional risk for severe outcomes, such as overdose, as users of illicit opioids are not monitored[12]. We examined different outcomes of opioid poisoning, i.e., death, prolonged hospitalization or complete recovery, in order to estimate whether the opioid crisis deepened since 2013
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