The Trends in Opioid Use in Castile and Leon, Spain: A Population-Based Registry Analysis of Dispensations in 2015 to 2018.

Francisco Herrera-Gómez,Paloma Criado-Espegel,F Javier Álvarez,Eduardo Gutierrez-Abejón,Ignacio Ayestarán

doi:10.3390/jcm8122148

Abstract

Opioids are driving-impairing medicines (DIM). To assess the evolution and trends of opioid analgesics use between 2015 and 2018 in Castile and Leon (Spain), a population-based registry study was conceived. The length of opioid use and its concomitant use with other DIMs were studied. Analyses were done considering age and gender distributions. Adjusted consumption for licensed drivers is also presented. Of the 5 million dispensations recorded between 2015 and 2018, opioid analgesics were dispensed to 11.44% of the general population and 8.72% of vehicle drivers. Increases among daily users (2.6 times higher) and chronic users (1.5% higher) were noted, supporting the overall increase in opioid use (1.5%). The use of multiple drugs including other DIMs was a common finding (mean ± SD, 2.54 ± 0.01). Acute use (5.26%) and chronic use (3.20%) were also frequent. Formulations combining opioid analgesics with nonopioid analgesics were preferred. The use of opioids increased in Spain between 2015 and 2018. Concomitant use with other DIMS especially affects women and the elderly. Frequent use of opioid analgesics with other DIMs is a serious problem for drivers and increases the risk of accidents. Promoting safe driving should be a main objective of health authorities, to be achieved by developing and implementing educational activities for healthcare professionals and patients.

Highlights

The nontherapeutic use of opioid analgesics has increased in the last 15 years, to the point where it is perceived as a serious public health concern [1]
Opioid use was associated with a mean ± SD of 2.54 ± 0.01 driving-impairing medicines (DIM) consumed, and was higher among women compared to men
Women consumed these medicines more frequently than men (13.73% versus 9.07%, χ2 = 3144.86, p = 0.001; Table 1), and this difference persisted among acute users (5.26%), chronic users (3.20%) and daily users (0.24%) of both types of formulations, with only one opioid and with a fixed combination of opioid analgesics and nonopioid analgesics (Table 1)

Summary

Introduction

The nontherapeutic use of opioid analgesics has increased in the last 15 years, to the point where it is perceived as a serious public health concern [1]. An increase in the number of cases of misuse, abuse, and death in most developed countries has been noted and attributed to the increase in opioid prescriptions [2], even considering disparities between world regions (the medical and nonmedical use of opioids have increased to a lower degree in Europe and Australia compared to Canada and the USA [3,4,5]). Clinicians, researchers, policy-makers, and drug developers from all over the world are aware of the problem: in October 2017, the USA declared the opioid epidemic a national public health emergency [7], according to data showing that opioids are the eighth most common cause of premature death [2]. In Spain, the prevalence of opioid use among drivers is 1.8% and the use of multiple drugs is a common finding (56.2%), but an increase in consumption remains to be clarified [13]

Results

Discussion

Conclusion