Community consumption of analgesic opioids and opiate substitution treatments in a self-employed workers health plan: trend, substitution effects and demographic factors

Abstract

Objective: Our aim was to evaluate community consumption of strong prescription opioid treatments in France in 2015 and 2017.Methods: A nation-wide French health care insurance claims database was analyzed for opioids average annual cost, annual prevalence of dispensations and users by mean of two repeated retrospective cross sectional study in 2015 and 2017.Results: In 2015–2017 prevalence of users per 100 000 beneficiaries per year rose from 878 to 932 (+6%) for strong opioid analgesics and lowered from 160 to 150 (-6%) for opiate substitution treatments. Prevalence of users of oxycodone, fentanyl, morphine, hydromorphone, buprenorphine, and methadone shifted by +17%, -5%, +4%, -8%, -13%, and +10%, respectively (+20% for methadone capsules). Oxycodone moved from third place to first place in terms of number of dispensation. Highest prevalence were in the western half of France, age over 60 and female for strong analgesic opioids and the north-east quarter and the south-west quarter of France, age 30 to 49 and male for opiate substitution treatments. The factor most strongly associated with prevalencewas age in strong analgesic opioids and gender in opiate substitution treatments.Conclusions: In 2 years the use of analgesics progresses, especially for oxycodone, while that of the substitution drugs decreases. Despite its greater danger, methadone tends to replace buprenorphine and capsule form tends to replace the syrup. Regulatory changes or enhanced controls may have played a role. The age of strong analgesic opioids consumers highlights the issue of severe pain in the elderly.