Long-term use of opioids and concomitant use of other habit-forming drugs.

Abstract

Long-term use of opioids may have undesirable consequences. We have investigated long-term opioid use in patient groups that were prescribed opioids for various indications (chronic pain, palliative care, other (white prescriptions, not generally covered by the Norwegian National Insurance Scheme)) as well as the groups' concomitant use of some other addictive medications. Persons registered in the Norwegian Prescription Database with at least one filled prescription of an opioid in the period 2011-19 were included. Long-term use in a calendar year was defined as the dispensing of >180 defined daily doses or >4500mg oral morphine equivalents distributed over at least 3 periods of 3 months. The number of long-term opioid users was 50422 in 2011 and 59996 in 2019 (10.1 and 10.7% of all opioid users). The number who received opioids on blue prescription (partly covered by the Norwegian National Insurance Scheme) for chronic pain increased in the period by 9952 persons, but the majority (n=38006, 63.3%) continued to receive opioids exclusively on white prescription in 2019. A total of 15623 (41.1%) and 14881 (39.2%), respectively, of the long-term opioid users who received opioids solely on white prescription in 2019 also received benzodiazepines and Z-hypnotics in the same year. Of the 23967 long-term users who also received benzodiazepines, 88% were dispensed opioids and benzodiazepines on the same day at least once in 2019. Prolonged prescribing of opioids on white prescription and concurrent prescribing of other addictive drugs may indicate undesirable use with no clear indication.