Abstract
Background: Excessive and non-medical use of prescription opioids is a public health crisis in many settings. This study examined the distribution of user types based on duration of use, trends in and associated factors of dispensing of prescription opioids in New South Wales and Victoria, Australia. Methods: 10% sample of unit-record data of four-year dispensing of prescription opioids was analysed. Quantities dispensed were computed in defined daily dose (DDD). Multilevel models examined factors associated with the duration of dispensing and the quantity dispensed in local government areas. Results: Overall, 53% were single-quarter, 37.3% medium-episodic (dispensed 2–6 quarters), 5% long-episodic (dispensed 7–11 quarters) and 5% were chronic users (dispensed 12–14 quarters). More than 80% of opioids in terms of DDD/1000 people/day were dispensed to long-episodic and chronic users. Codeine and oxycodone were most popular items—both in terms of number of users and quantity dispensed. Duration of dispensing was significantly higher for women than men. Dispensing quantity and duration increased with increasing age and residence in relatively poor neighborhoods. Conclusions: Although only 5% were chronic users, almost 60% of opioids (in DDD/1000 people/day) were dispensed to them. Given that chronic use is linked to adverse health outcomes, and there is a progression toward chronic use, tailored interventions are required for each type of users.
Highlights
In many countries there has been a growing concern about the increase in utilisation of prescription opioids (PROP) such as tramadol, oxycodone, fentanyl, codeine, morphine and buprenorphine
Some medicines are not listed in the Pharmaceutical Benefits Schemes (PBS) or Repatriation Pharmaceutical Benefits Scheme (RPBS), and patients pay the full price for those items as a private prescription
Ten percent sample of de-identified unit-record dispensing data of prescription opioids was supplied by the Australian Government Department of Human Services
Summary
In many countries there has been a growing concern about the increase in utilisation of prescription opioids (PROP) such as tramadol, oxycodone, fentanyl, codeine, morphine and buprenorphine. While opioid analgesics rapidly relieve many types of pain and improve function, the evidence that there is a positive correlation—much of which is causal—between the magnitudes of PROP dispensing and adverse health outcomes arising from both their medical (e.g., dependence) and nonmedical use (e.g., fatal overdoses) [7,8] is growing. The combination of poor health outcomes from long-term utilisation, [10] inappropriate prescribing for pain, and non-medical use of opioids has resulted in a range of adverse consequences including high number of opioid-related deaths [11,12]. Recent dispensing data suggests overall utilisation of opioids remains mostly stable, the number of individuals who were dispensed an opioid increased over the years [14] In these circumstances, it would be valuable to know if the growth in number of individuals is attributable to short-term or chronic users. This study, examined the distribution of PROP user types in New South Wales and Victoria, the two most populous Australian states, trends in PROP dispensing and the associated factors
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