Strong Analgesics Research Articles

Doctor shopping of opioid analgesics relative to benzodiazepines: A pharmacoepidemiological study among 11.7 million inhabitants in the French countries

BackgroundThe abuse of prescription opioids and its subsequent consequences is an important public concern particularly in the USA. The literature on opioid analgesic abuse is scarce. ObjectiveWe assess the extent and risk of opioid analgesics abuse relative to benzodiazepines (BZD) using the doctor shopping method, taken into account the pharmacological characteristics (dosage, route of administration, extended or immediate release). MethodsWe used SNIIRAM database covering 11.7 million inhabitants. All individuals with at least one reimbursement for non-injectable opioid analgesic or BZD in 2013 were included. Opioids for mild to moderate pain and for moderately severe to severe pain were studied. The Doctor Shopping Quantity (DSQ) is the quantity obtained by overlapping prescriptions from several prescribers. The Doctor Shopping Indicator (DSI) is the DSQ divided by the total dispensed quantity. ResultsThe strong opioid analgesics have the highest DSI (2.79%) versus 2.06% for BZD hypnotics. Flunitrazepam ranked first according to its DSI (13.2%), followed by morphine (4%), and zolpidem (2.2%). The three-strong opioids having the highest DSI were morphine, oxycodone and fentanyl (respectively 4%, 1.7% and 1.5%). The highest DSI was observed for the highest dosages of morphine (DSI = 8.4% for 200 mg) and oxycodone (DSI = 2.8% for 80 mg). The highest DSI for fentanyl was described with nasal and transmucosal forms (4.1% and 3.3% respectively). The highest DSI for morphine was described for extended-release (4.1%). ConclusionThere is a need to reinforce surveillance systems to track opioid misuse and to increase awareness of healthcare professionals.

Survey of the Period of Tapering of a Strong Opioid Analgesic for Oral Mucositis Resulting from Concomitant Chemoradiotherapy for Head and Neck Cancer after the End of Treatment

Survey of the Period of Tapering of a Strong Opioid Analgesic for Oral Mucositis Resulting from Concomitant Chemoradiotherapy for Head and Neck Cancer after the End of Treatment

Analgesic and Opioid Use in Pain Associated with Head-and-Neck Radiation Therapy.

Aim:The aim of the study is to find the incidence of analgesic and opioid use in pain associated in HNC patient undergoing radiation therapy.Background:Radiation therapy with concurrent chemotherapy has become the standard of care in head and neck cancer. Acute toxicity like mucositis and dysphagia has increased with aggressive therapy. Pain is an invariable accompaniment of oropharyngeal mucositis, which leads to decreased quality of life and treatment break.Materials and Methods:This is a retrospective review of radiation charts of head and neck patients treated from January 2013 to June 2017 at St. John's Medical college and Hospital, Bengaluru.Results:A total of 138 (92%) patients required analgesia during the radiation course. The analgesic consumption started increasing from week 2, peaked at week 5, persist for 6 weeks and started declining after week 10. 52% patients required opioids, especially from week 4 to week 8. 15% of patients required Morphine, the maximum use in week 6 to week 8. The use of chemotherapy (P = 0.031), presence of grade 3 mucositis (P = 0.010) and grade 3 dysphagia (P = 0.001) were significantly associated with severe pain (use of strong opioids). All 80 (100%) patients receiving concurrent chemotherapy required analgesia. More than 80% patients required opioids and one fourth required strong analgesic in concurrent chemotherapy group.Conclusion:More than 90% of all head and neck cancer patient undergoing radiation therapy experience therapy related pain for more than 6 weeks. 53% of the patients require opioids and 15% require strong opioids. The use of concurrent chemotherapy was significantly associated with severe pain.

Access to Palliative Care Services: A Qualitative Study of Experiences of Children and Families Attending University Teaching Hospital in Lusaka

Introduction: WHO recommends provision of palliative care for all who need it according to needs and context. However, in Sub-Saharan Africa coverage of palliative care services remain low especially children. This study reports experiences of palliative care services for children and their families attending the University Teaching hospital in Lusaka, Zambia. Methodology: The was a cross-sectional qualitative study conducted at University teaching hospital in Lusaka, Zambia. Results: The major challenges faced by families included lack of economic/financial and bereavement support. Most families were referred to the UTH from very far places without any form of support. One major barrier identified to provision of palliative care was poor coordination of services with most patients missing out on services which were already available. While social workers were available, poor funding negatively affected this service. There were very few trained health workers in palliative care. Pain management remained poor with many clinicians still not comfortable to prescribe stronger analgesia such as morphine for severe pain. Conclusion: The study revealed significant gaps for children’s palliative care services in at the University teaching hospital in Zambia. One major barrier identified to provision of palliative care was poor coordination of services. Families reported lack of economic and bereavement support in addition to lack of information.

Mina tratatzeko estrategia farmakologiko berriak: kannabinoideak

Ehunetako benetako kaltearekin edo kalte potentzialarekin erlazionatutako esperientzia sentsorial eta emozional desatsegina da mina, eta sailka daiteke jatorriaren arabera (nozizeptiboa, neuropatikoa), larritasunaren arabera (arina, larria) zein iraupenaren arabera ere (akutua, kronikoa). Oro har, gaur egun mina tratatzeko merkaturatuta dauden farmakoak eraginkorrak dira, baina epe luzera erabiltzean arazoak ager daitezke. Adibidez, opiazeoak analgesiko indartsuak diren arren, kronikoki ematean haien eraginkortasuna txikitu daiteke eta eragin desiragaitzak agertu. Estatistikak dio populazioaren % 15ek min kronikoa jasaten duela. Min kronikoak norbanakoa ezindu dezake eta hura arintzea zaila gerta daiteke. Horregatik, mina tratatzeko estrategia eta itu berrien ikerketak beharrezkoak dira. Ikergai dagoen itu bat sistema kannabinoidea da. Barneko kannabinoideak giza gorputzak ekoizten dituen molekulak dira, zeinek kannabinoide-hartzaileei (CB) lotuz funtzio fisiologiko ugari erregulatzen dituzten, mina adibidez. Cannabis generoko landareetan aurki daitezkeen landare-kannabinoideek barneko sistema horren aktibazioaz baliatuz analgesia eragin dezakete. Zoritxarrez, horietako kannabinoide batzuk psikoaktiboak dira, minaren tratamendurako mugatzailea den ezaugarria. Horregatik, azken urteotan kannabinoide ez-psikoaktiboen gaineko ikerkuntzek bultzada handia jaso dute eta minaren tratamendurako kannabinoide psikoaktibo eta ezpsikoaktiboen arteko nahasketak zenbait saio klinikotan probatu dira. Azkenik, eraginkortasun/segurtasun erlazioa hobetzeko asmoz, kannabinoide eta opiazeoen elkarketak ikertu izan dira, eragin analgesiko sinergikoa lortzeko eta dosi txikiagoak erabilita segurtasuna handitzeko. Beraz, kannabinoideen inguruko ikerkuntzak bide berriak zabaltzen ditu minaren tratamendurako estrategia farmakologiko hobeak bilatzeko.

Self-management toolkit and delivery strategy for end-of-life pain: the mixed-methods feasibility study.

Pain affects most people approaching the end of life and can be severe for some. Opioid analgesia is effective, but evidence is needed about how best to support patients in managing these medicines. To develop a self-management support toolkit (SMST) and delivery strategy and to test the feasibility of evaluating this intervention in a future definitive trial. Phase I - evidence synthesis and qualitative interviews with patients and carers. Phase II - qualitative semistructured focus groups and interviews with patients, carers and specialist palliative care health professionals. Phase III - multicentre mixed-methods single-arm pre-post observational feasibility study. Phase I - six patients and carers. Phase II - 15 patients, four carers and 19 professionals. Phase III - 19 patients recruited to intervention that experienced pain, living at home and were treated with strong opioid analgesia. Process evaluation interviews with 13 patients, seven carers and 11 study nurses. Self-Management of Analgesia and Related Treatments at the end of life (SMART) intervention comprising a SMST and a four-step educational delivery approach by clinical nurse specialists in palliative care over 6 weeks. Recruitment rate, treatment fidelity, treatment acceptability, patient-reported outcomes (such as scores on the Brief Pain Inventory, Self-Efficacy for Managing Chronic Disease Scale, Edmonton Symptom Assessment Scale, EuroQol-5 Dimensions, Satisfaction with Information about Medicines Scale, and feasibility of collecting data on health-care resource use for economic evaluation). Phase I - key themes on supported self-management were identified from evidence synthesis and qualitative interviews. Phase II - the SMST was developed and refined. The delivery approach was nested within a nurse-patient consultation. Phase III - intervention was delivered to 17 (89%) patients, follow-up data at 6 weeks were available on 15 patients. Overall, the intervention was viewed as acceptable and valued. Descriptive analysis of patient-reported outcomes suggested that interference from pain and self-efficacy were likely to be candidates for primary outcomes in a future trial. No adverse events related to the intervention were reported. The health economic analysis suggested that SMART could be cost-effective. We identified key limitations and considerations for a future trial: improve recruitment through widening eligibility criteria, refine the SMST resources content, enhance fidelity of intervention delivery, secure research nurse support at recruiting sites, refine trial procedures (including withdrawal process and data collection frequency), and consider a cluster randomised design with nurse as cluster unit. (1) The recruitment rate was lower than anticipated. (2) The content of the intervention was focused on strong opioids only. (3) The fidelity of intervention delivery was limited by the need for ongoing training and support. (4) Recruitment sites where clinical research nurse support was not secured had lower recruitment rates. (5) The process for recording withdrawal was not sufficiently detailed. (6) The number of follow-up visits was considered burdensome for some participants. (7) The feasibility trial did not have a control arm or assess randomisation processes. A future randomised controlled trial is feasible and acceptable. This study is registered as PROSPERO CRD42014013572; Current Controlled Trials ISRCTN35327119; and National Institute for Health Research (NIHR) Portfolio registration 162114. The NIHR Health Technology Assessment programme.

Computational insights into the subtype selectivity and "message-address-efficacy" mechanisms of opioid receptors through JDTic binding and unbinding.

In drug design and discovery, binding affinity and selectivity are two basic properties of a drug candidate. Opioid receptors (ORs) are the main targets of strong analgesics. Like some other class A members of G-protein-coupled receptors (GPCRs), ORs exhibit complex selectivity on their ligands. The diversity of binding activity and selectivity among opioids has deeply attracted researchers for a long time. To investigate the subtype selectivity of μ, δ and κ ORs in detail, using the κ-selective antagonist JDTic as a probe, we performed a series of computational simulations, including molecular dynamics and metadynamics, on JDTic-μ/δ/κ-OR complexes. From the simulations, we found that the decisive factor of JDTic selectivity on the μ-subtype was the 2.63 position, which affected the efficacy of JDTic through changing the dynamics of the Q2.60 residue. In addition to the 2.63-position residue, the 7.35 position was the other crucial aspect of JDTic selectivity for the δ-subtype. Based on the results, we suggest a new concept, the "message-address-efficacy" hypothesis, to explain the relationships among the affinity, selectivity and function between ORs and opioids. Thus, all the detailed dynamics of JDTic-bound ORs might be helpful to deeply understand the subtype selectivity and binding mechanisms of other GPCRs.

PP29 Exploring factors increasing paramedics’ likelihood of administering analgesia in pre-hospital pain: cross sectional study (explain)

BackgroundParamedics play an important role in reducing pain in patients calling an ambulance. We aimed to identify how patient factors (age, sex), clinical condition and paramedic factors (sex, role seniority)...

O-8 The pharmacokinetics of fentanyl and its derivatives in children – a comprehensive review

Background Fentanyl and its newer derivatives sufen-tanil, alfentanil and remifentanil are strong opioid anal-gesics frequently used in pediatricpatients. Despite this extensive use insufficient information on the PK of these drugs in neonates, infants, children and adolescents is available. The goal of this analysis was to perform a thor-ough review of the PK properties of fentanyl and its deriv-atives in children of all age groups. Methods PubMed was searched using specific terms re-lated to the pharmacology of fentanyl and its derivatives in the paediatric population. Original articles and reviews regarding the PK, PD, efficacy and safety were included. A meta-analysis of PK data was conducted using a ran-dom effects model. Individual PK data was re-analysed for subgroups. Results Of the retrieved 372 articles, clinical studies were the most frequent, followed by case series, case and short reports, and reviews. Fentanyl and its derivatives show a satisfactory safety profile in children. Forty four eligible PK studies contained data from 821 paediatric patients, including more than 46 preterm infants, 64 neonates, 115 infants and toddlers, 188 children, and 28 adolescents. Special populations comprised preterm infants, children with chronic renal or liver disease, undergoing extracor-poreal circulation, or with obesity. Pooled mean fentanyl clearance (CL) was 14.56 (95% CI 12.16, 16.74) mL/min/kg and volume of distribution (Vd) was 5.46 (2.64, 10.27) L/kg. Mean sufentanil CL was 19.43 (12.77, 26.09) mL/min/kg and Vd was 2.39 (1.63, 3.15) L/kg. Alfentanil CL was 6.23 (4.44, 8.02) mL/min/kg and Vd was 0.57 (0.42, 0.72) L/kg. There was only weak correlation between body weight (BW) and both CL and Vd of fentanyl (r2=0.22 and r2=0.43, p=0.0054 and p Conclusion There are profound differences between the fentanyl derivatives and their PK correlations with BW. Fu-ture studies should be designed to assess the PK and PD of fentanyl and its derivatives in all paediatric subpopulations.

Oxycodone for cancer-related pain.

Oxycodone for cancer-related pain.

Prescribing opioids in general practice

In this scenario you are working as a practice nurse in a large GP practice. Your local formulary recommends morphine as the first line strong opioid analgesic. Your practice pharmacist has analysed your prescribing data to check whether prescribing is in accordance with the formulary. The analysis reveals that the practice is prescribing a large proportion of non-formulary or second line strong opioids. In the average UK practice, morphine makes up 30% of all strong opioids prescribed. In your practice, it makes up just 20% of all strong opioids prescribed. Your pharmacist has identified a list of 50 patients on non-formulary or second line strong opioids, all for chronic pain

Sedation and analgesia practices at Italian neonatal intensive care units: results from the EUROPAIN study

BackgroundWe aimed to examine current bedside analgesia/sedation (A/S) and pain assessment (PA) practices in Italian neonatal intensive care units (NICUs) in relation to the findings of an epidemiological European study and recently-introduced national guidelines.MethodsWe analyzed the Italian data from the EUROPAIN (EUROpean-Pain-Audit-In-Neonates) prospective observational study on A/S practices that involved 6680 newborns admitted to tertiary-level NICUs in 18 European countries. Demographics, type of assisted ventilation, type and mode of A/S administration and PA were analyzed. Multivariate linear regression models were used to identify factors predicting A/S and PA practices.ResultsFrom October 1st, 2012 to June 30th, 2013, thirty Italian NICUs gathered data on 422 newborn: 131 on invasive ventilation (IV); 150 on noninvasive ventilation (NIV); and 141 on spontaneous ventilation (SV). A/S was documented for 35.3% of all infants admitted (86.3% IV; 17.3% NIV; 7.1% SV [p = 0.0001]), and varied considerably between NICUs (as reported in other European countries). Strong analgesics were used in 32.5% of cases, sedatives in 10.2%, mild analgesics in 3.8%. Fentanyl was used in 78.6% of cases, morphine in 8.4%, neuromuscular blockers in 5.3%, midazolam in 22.1%. The performance of PA was documented in 67.5% of all newborn (85.5% IV; 67.3% NIV; 51.1% SV [p = 0.001]). Illness severity, type of ventilation, bedside PA, and number of NICU beds were all factors associated with A/S use on multivariate analysis, while gestational age ≤ 32 weeks, and type of ventilation and presence of a pain team were associated with PA.ConclusionsWe documented a generally widespread, but still highly variable use of A/S and PA at Italian NICUs, despite the diffusion of national guidelines. There is an urgent need to improve routine PA to enable customized pain and stress control (and prevention) in all infants.Trial registrationClinical Trials.gov # NCT01694745.

Pain in Patients with Pancreatic Cancer: Prevalence, Mechanisms, Management and Future Developments.

Pain affects approximately 80% of patients with pancreatic cancer, with half requiring strong opioid analgesia, namely: morphine-based drugs on step three of the WHO analgesic ladder (as opposed to the weak opioids: codeine and tramadol). The presence of pain is associated with reduced survival. This article reviews the literature regarding pain: prevalence, mechanisms, pharmacological, and endoscopic treatments and identifies areas for research to develop individualized patient pain management pathways. The online literature review was conducted through: PubMed, Clinical Key, Uptodate, and NICE Evidence. There are two principal mechanisms for pain: pancreatic duct obstruction and pancreatic neuropathy which, respectively, activate mechanical and chemical nociceptors. In pancreatic neuropathy, several histological, molecular, and immunological changes occur which correlate with pain including: transient receptor potential cation channel activation and mast cell infiltration. Current pain management is empirical rather etiology-based and is informed by the WHO analgesic ladder for first-line therapies, and then endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) in patients with resistant pain. For EUS-CPN, there is only one clinical trial reporting a benefit, which has limited generalizability. Case series report pancreatic duct stenting gives effective analgesia, but there are no clinical trials. Progress in understanding the mechanisms for pain and when this occurs in the natural history, together with assessing new therapies both pharmacological and endoscopic, will enable individualized care and may improve patients' quality of life and survival.

Interleukin-1\u03b2 pre-treated bone marrow stromal cells alleviate neuropathic pain through CCL7-mediated inhibition of microglial activation in the spinal cord

Although neuropathic pain is one of the most intractable diseases, recent studies indicate that systemic or local injection of bone marrow stromal cells (BMSCs) decreases pro-inflammatory cytokines release and alleviates neuropathic pain. However, it is still not clear whether pre-treated BMSCs have a strong anti-inflammatory and/or analgesia effect. Using the spinal nerve ligation model of neuropathic pain, IL-1β pre-treated BMSCs (IL-1β-BMSCs) were injected into rats followed by SNL in order to determine possible effects. Results indicated that IL-1β-BMSCs were more efficacious in both amelioration of neuropathic pain and inhibition of microglia activation. Specifically, microglia inhibition was found to be mediated by chemokine C-C motif ligand 7 (CCL7) but not CCL2. Results also showed that IL-1β-BMSCs had a stronger inhibitory effect on astrocyte activation as well as CCL7 release, which was found to be mediated by IL-10 not transforming growth factor-β1. In addition, we also found directional migration of IL-1β-BMSCs was mediated by inceased C-X-C motif chemokine ligand (CXCL) 13 expression following SNL. In conclusion, our results indicated IL-1β-BMSCs could inhibit microglia activation and neuropathic pain by decreasing CCL7 level in spinal cord.

The role of oxycodone/naloxone in pain management

ABSTRACT: Strong opioid analgesics are essential for pain treatment of moderate to severe intensity, regardless of its etiology. An important factor limiting safety and efficacy of opioids are side effects, particularly gastrointestinal. Constipation as part of opioid induced bowel dysfunction is one of the most common reason for discontinuation of strong opioids. Introduction of novel oxycodone/naloxone formulation is an attempt to resolve the problem of opioid induced gastrointestinal side effects. On the basis of clinical trials from 2008-2016 the authors discuss the applicability of oxycodone/naloxone prolonged release in management of different pain syndromes in humans, in cancer patients, in neuropathic pain patients, in the elderly, in acute post-operative pain and other clinical indications for example restless leg syndrome. Presented data indicate comparable or in some cases even better analgesic efficacy of oxycodone with naloxone and lower risk of gastrointestinal side effects, especially constipation, when compared to other strong opioids. The introduction of oxycodone with naloxone significantly expands treatment options for chronic pain patients, likewise improving safety and thus the effectiveness of treatment with strong opioids.

Swallowing action immediately before intravenous fentanyl at induction of anesthesia prevents fentanyl-induced coughing: a randomized controlled study.

Fentanyl is a strong µ-opioid analgesic which attenuates the stimulation of surgical invasion and tracheal intubation. However, intravenous fentanyl often induces coughing [fentanyl-induced coughing (FIC)] during induction of anesthesia. We found that the swallowing action, when requested at induction of anesthesia, attenuated FIC. In the current study, we investigated the relationship between the occurrence of FIC and the swallowing action. The study included American Society of Anesthesiologists physical status I or II patients, aged 20-64years, who were undergoing elective surgery. They were divided into two groups-one group was urged to perform the swallowing action immediately before intravenous fentanyl (S group), and the other group performed no swallowing action (non-S group). The patients first received intravenous fentanyl and were observed for 90s. Each patient's background, dose of fentanyl and occurrence of coughing were investigated from their records and a motion picture recording. The incidence of FIC was evaluated by chi-squared test, and severity was tested by Wilcoxon rank-sum test. P<0.05 was considered statistically significant. The incidence of FIC in the S group and non-S group was 14.0 and 40.4%, respectively. The risk of FIC was reduced in the S group by 75%; risk ratio (95% confidence interval) was 0.35 (0.20, 0.60). The number of coughs in the S group were less than in the non-S group (P<0.001). The swallowing action immediately before intravenous fentanyl may be a simple and clinically feasible method for preventing FIC effectively. Clinical trial number: UMIN000012086 ( https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&type=summary&recptno=Rn000014126&language=J ).

A Study on Laparoscopic Sacral Colpopexy for Uterine Prolapse.

ObjectivesWe sought to describe the perioperative and postoperative adverse events associated with sacral colpopexy and evaluate the surgical outcome, complications, and benefits of laparoscopic sacral fixation for patients with pelvic prolapse.MethodsNinety-two women with uterine prolapse underwent sacral colpopexy between January 2011 and September 2016 at Chosun University Hospital. Patients' electronic medical records were investigated for demographic, intraoperative, and postoperative data. Strict definitions were used for all clinically relevant adverse events. Patients' outcomes were documented with 1 self-administered quality of life questionnaires: the Pelvic Floor Distress Inventory-20 focused on symptom distress. The primary analysis looking at perioperative and postoperative adverse events was descriptive and statistics were reported for all groups as n/N (%) with 95% confidence intervals for categorical variables and as mean ± standard deviation and mean (range) for all continuous variables.ResultsTheir mean age was 69 ± 8.1 years, mean follow-up duration was 12 months, and mean operating time was 61 minutes. There were seven conversions due to anesthetic or surgical difficulties. Follow-up was performed using a telephone questionnaire and physical examination at 12 months. There were three cases of sacral pain with strong analgesics, one of vaginal erosion, two of transient urinary retentions, one of spondylitis, and two of mesh infection. Of the patients, 98.9% were satisfied with the surgical results, while none complained of sexual dysfunction or problems performing her usual activities.ConclusionsLaparoscopic sacral colpopexy is a feasible and highly effective technique that offers good long-term results with complication rates similar to those of open surgery with the added benefit of being minimally invasive.

Strong opioid analgesics in therapy for chronic pain syndrome. Which drug should be preferred?

Strong opioid analgesics in therapy for chronic pain syndrome. Which drug should be preferred?

Low dose ketamin

Ketamine binds non-competitive against a phencyclidine receptors bound N-methyl-D-aspartate (NMDA), a receptor that is involved in the pathophysiology of acute pain. Ketamine has been used as an intravenous anesthesia, analgesia for acute and chronic pain at a dose of subanaesthetic. Ketamine is a dissociative anesthetic produces a state with a characteristic strong analgesia, amnesia, and catalepsy. Dissociative components resulting from the effect on the limbic system and talamoneokortikal. Lowdose ketamine as known as analgesia dose ketamine or subanestesia dose is 0.2 to 0.75 mg / kg IV. At low doses, ketamine does not increase the effect psychomimetic like dissociation or deep sedation. The combination with midazolam provides satisfactory sedation, amnesia and analgesia without significant cardiovascular depression.

Accessibility of opioid analgesics and barriers to optimal chronic pain treatment in Poland in 2000\u20132015

PurposeBased on the international reports, consumption of opioid analgesics in Poland is relatively low. There is limited information on possible impediments to optimal opioid use. This study was aimed to identify possible barriers to access to opioid analgesics and causes of failure to comply with current clinical guidelines.MethodsConsumption data per capita in 2000–2015 were analyzed in terms of oral morphine equivalents in total, per prescription type, per reimbursement status, to identify the impact of regulations specific for Poland.ResultsThe consumption of opioid analgesics has been consistently growing from 36.0 in 2000 to 103.4 mg oral morphine equivalents (OME) per capita in 2015, mainly thanks to strong opioid consumption growth. Tramadol is the most commonly used opioid in Poland. Fentanyl and buprenorphine transdermal formulations are the most frequently used strong opioid analgesics in terms of OME. The vast majority (92.8 %) of opioids were distributed upon for outpatient use in 2015, with a almost fourfold growth of consumption of strong opioids and almost threefold of weak opioids between 2000 and 2015. Strong opioids were 41 % of OME used upon prescription in 2015. Acceleration of consumption growth has been observed since 2013.ConclusionsThe prescription pattern does not abide by the current clinical guidelines for pain treatment, and the most often used opioids in Poland are tramadol, buprenorphine, and fentanyl. The use of opioids in Poland grows fast, with acceleration since 2013. The most important legal impediments of optimal opioid analgesics use have been lack of reimbursement, special prescription forms, and complicated prescribing rules.