Abstract
Opioid analgesics are reported to be overprescribed in various parts of the world. Since data for South Africa in its entirety is not available, studies on available electronic dispensing databases can add a valuable insight into opioid prescribing patterns in the country. The primary aim of the study was to determine which opioids are prescribed in a medical insurance scheme setting in South Africa. A retrospective drug utilisation study was conducted on a South African medical insurance administrator database for 2017. The database contained 3 898 535 records for medicine, medical devices and procedures. All products in ATC subgroup N02A (opioids) were extracted and analysed. A total of 102 255 opioids were dispensed to 33 249 patients (72.47% male patients). The average age of patients was 40.80 (SD=12.26) years. Patients received on average 3.08 (SD=5.57) opioid prescriptions over the year. Most opioids were dispensed by private hospitals (46.45%), followed by general medical practices (43.38%) and pharmacies (9.74%). Dihydrocodeine and paracetamol (N02AJ06, 45.09%) were dispensed the most, followed by tramadol (N02AX02, 28.99%), and tramadol and paracetamol combined (N02AJ13, 9.67%). These three agents together accounted for 83.75% of all opioid analgesics dispensed. Pethidine (N02AB02) accounted for 4.74% and morphine (not in combination) (N02AA01) for 4.48%. A total amount of R2 560 040.07 was claimed by patients, of which R2 004 941.77 was reimbursed. Generic substitution is compulsory in South Africa. The average amount claimed per opioid was only R25.04 (SD=R56.72). Tramadol was, for example, dispensed as its originator, in addition to seven branded generics. Opioid prescribing seemed to be in line with the South African guidelines, and overuse could not be detected. A follow-up study focusing specifically on codeine is recommended, since South Africa is often portrayed in the media as one of the codeine hotspots in the world.
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