Use of tramadol and other analgesics following media attention and risk minimization actions from regulators: a Danish nationwide drug utilization study

Anne Mette Skov Sørensen,Mona Vestergaard Laursen,Anton Pottegård,Lotte Rasmussen,Espen Jimenez-Solem,Martin Thomsen Ernst,Stine Hasling Mogensen

doi:10.1007/s00228-020-03016-6

Abstract

PurposeTo describe the use of tramadol and other analgesics in Denmark focusing on the impact of media attention (June and December 2017) and regulatory actions (September 2017 and January 2018) on the use of tramadol.MethodsUsing nationwide registries, we identified all adults who filled a prescription for tramadol and other analgesics from 2014 to 2019. We described incidence rates, prevalence proportions, and total use of tramadol and other analgesics over time. We also described switching between analgesics, treatment duration, skewness in drug use, and doctor-shopping.ResultsFrom early 2017 until the end of 2019, total tramadol use decreased markedly while the use of morphine and oxycodone decreased slightly. The quarterly prevalence of tramadol use decreased from 32/1000 individuals in 2014 to 18/1000 at the end of 2019, dropping mainly at the time of media attention. Concomitantly, the quarterly prevalence increased for oxycodone (from 5.1 to 8.2) and morphine (from 8.5 to 9.8), mainly due to more short-term and sporadic users, and decreased for codeine (14 to 9.6). From 2014 to mid-2017, the incidence of tramadol use was stable (around 2.2/1000 person-months) but dropped in June 2017 to 1.7/1000, coinciding with the media attention. The incidence of tramadol use continued to decrease (to 1.1/1000 at the end of 2019).ConclusionWe identified a decline in tramadol use coinciding with the media attention in 2017 and continuing during regulatory actions. There was generally no evidence of unintended effects on the utilization of opioids related to the media attention and regulatory actions.

Highlights

The use of prescription opioids, including tramadol, has increased worldwide during the last decades resulting in a dramatic increase in overdoses and opioid use disorders, especially in the USA [1,2,3]
In this descriptive nationwide drug utilization study, we used the Danish health care registries to describe the use of tramadol and other analgesics including other opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), gabapentinoids, tricyclic antidepressants (TCAs), and serotonin and norepinephrine reuptake inhibitors (SNRIs) in adults from 2014 to 2019
We divided the analysis into seven parts where we described the use of tramadol and other analgesics during 2014–2019 and described changes in treatment patterns over time by comparing three study years, i.e., 2016, 2017, and 2019

Summary

Introduction

The use of prescription opioids, including tramadol, has increased worldwide during the last decades resulting in a dramatic increase in overdoses and opioid use disorders, especially in the USA [1,2,3]. In Denmark, the total use of tramadol increased twofold from 2001 to 2013 [4]. From 2006 to 2016, the prevalence of tramadol use was markedly higher in Denmark compared to Sweden and Norway [5], these countries have rather similar health care systems and cultures. Tramadol is a centrally acting synthetic opioid with monoaminergic actions, and both abuse and addiction have been reported in several previous studies [6, 7]. Tramadol has been considered as having a limited potential for abuse and addiction [6, 8, 9] and this matter has in recent years been an issue of growing concern in Denmark [10,11,12].

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