Too much or too little opioids to patients receiving opioid agonist therapy in Norway (2013\u20132017): a prospective cohort study

Jørn Henrik Vold,Lars Thore Fadnes,Kjell Arne Johansson,Christer Aas,Svetlana Skurtveit

doi:10.1186/s12913-020-05504-y

Abstract

BackgroundDispensations of opioid analgesics to patients on opioid agonist therapy (OAT) may increase the risk of overdoses. The current study’s objectives are to investigate the dispensation rates and mean daily doses of dispensed opioid analgesics among patients who received OAT opioids in Norway during 2013–2017 and evaluate whether discontinuing OAT opioids affects the dispensed dose of opioid analgesics.MethodsInformation on opioids was collected from the Norwegian Prescription Database. Dispensation rates were calculated by dividing the number of patients who were dispensed at least one opioid analgesic by the number of patients who were dispensed an OAT opioid. We calculated the mean daily dose of opioid analgesics in oral morphine equivalents. The OAT opioid dose was defined as a ratio between the dispensed doses divided by the mean recommended dose. We used logistic regression to estimate the association between the dispensation of an opioid analgesic, a dose of OAT opioids, having chronic pain, and being on palliative care.ResultsA total of 10,371 patients were dispensed at least one OAT opioid during the study period. In 2017, 18% were dispensed an opioid analgesic with a mean daily dose of 29 mg of oral morphine equivalents. Being dispensed an opioid analgesic was associated with having chronic pain (adjusted odds ratio (aOR): 3.6, 95% confidence interval: 3.2–4.2), being on palliative care (aOR: 6.1, 4.7–7.9), and receiving an OAT opioid dose below half of the recommended OAT dose (aOR: 1.7, 1.4–2.0). Similar results were seen in 2013–2016. The discontinuation of OAT opioids could increase the dose of dispensed opioid analgesics.ConclusionReducing the dispensation of opioid analgesics can be achieved by increasing the OAT opioid dose for patients on a low OAT dose, and by extending the period needed to taper off the OAT opioid dose at discontinuation.

Highlights

Dispensations of opioid analgesics to patients on opioid agonist therapy (OAT) may increase the risk of overdoses
We presented the total dispensed doses of opioid analgesics as a mean daily dose per patient per year stated in oral morphine equivalents (OMEQ)
We evaluated the association between being dispensed an opioid analgesic and the number and type of dispensed OAT opioids, as well as the OAT opioid dose ratio, the patient’s age and gender, and whether they had chronic pain or were on palliative care

Summary

Introduction

Dispensations of opioid analgesics to patients on opioid agonist therapy (OAT) may increase the risk of overdoses. More than 20% percent of patients on OAT have psychiatric disorders such as attention deficit hyperactivity disorder [5], personality disorders [1], or psychosis diseases, and nearly 50% have other drug dependencies that may influence their ability to follow up the dispensed opioid analgesics as dosed [6, 7]. In these cases, concomitant dispensations of several opioids may potentially affect the risk of overdose deaths and intoxications, as well as aggravate pain if the opioids are not handled correctly [8,9,10]. There has been limited research on dispensations of opioid analgesics to patients on OAT and the characteristics of patients dispensed opioid analgesics and OAT opioids concomitantly [20]

Methods

Results

Conclusion