Opioid Prescription in Switzerland: Appropriate Comedication use in Cancer and Noncancer Pain.

BACKGROUND In Europe, limited information on the use of opioids is available. OBJECTIVES To assess how guideline recommendations to manage opioid-related adverse events were followed in cancer- and noncancer-related opioid use. STUDY DESIGN Analysis of health insurance data of one of the major health insurers in Switzerland. SETTING All opioid claims between 2006 and 2014. METHODS Opioid episodes were cancer-related when cancer treatments were used within ± 3 months of the first opioid claim. Recurrent strong episodes were defined as >/= 2 opioid claims with at least one strong opioid claim. Episode duration were acute (< 90 days), subacute, or chronic (>/= 120 days >/= 90 days +>/= 10 claims). RESULTS Out of 591,633 opioid episodes 76,968 (13%) were recurrent episodes: 94% were noncancer related (83% in recurrent episodes) and 6% cancer related (17% recurrent). Chronic opioid use was observed in 55% (noncancer) and 58% (cancer) recurrent episodes. Recommended laxatives were used in 50% noncancer and in 67% cancer episodes. Antiemetic drugs were used in 54% noncancer and in 83% cancer episodes. Not recommended coprescription of benzodiazepines was observed in 34% recurrent noncancer and 46% cancer episodes. LIMITATIONS No clinical information was available to assess the indication for opioid use. CONCLUSIONS In this study, opioids were primarily used outside the context of cancer-related treatment. In noncancer-related opioid use, we found a substantial higher proportion without recommended laxative and antiemetic medications. Coprescription of benzodiazepines may increase the risk for opioid overdose and was present in one-third of the noncancer episodes and in almost every second cancer episode. KEY WORDS Pain medications, opioids, nonopioids, benzodiazepines, health insurance claims data, cancer pain, noncancer pain, chronic opioid use, adverse events prevention, guideline recommendations.

[1]  Brandon Galarita,et al.  Chronic , 2020, Definitions.

[2]  K. Jordan,et al.  Risk of adverse events in patients prescribed long‐term opioids: A cohort study in the UK Clinical Practice Research Datalink , 2019, European journal of pain.

[3]  A. Walker,et al.  Opioid prescribing trends and geographical variation in England, 1998-2018: a retrospective database study. , 2019, The lancet. Psychiatry.

[4]  C. Bosetti,et al.  Trends in the consumption of opioids for the treatment of severe pain in Europe, 1990–2016 , 2018, European journal of pain.

[5]  E. Shipton,et al.  A Review of the Opioid Epidemic: What Do We Do About It? , 2018, Pain and Therapy.

[6]  Joseph W. Frank,et al.  Patient Outcomes in Dose Reduction or Discontinuation of Long-Term Opioid Therapy , 2017, Annals of Internal Medicine.

[7]  T. Teunis,et al.  An epidemic of the use, misuse and overdose of opioids and deaths due to overdose, in the United States and Canada: is Europe next? , 2017, The bone & joint journal.

[8]  F. Andersohn,et al.  Prevalence and Incidence Trends for Diagnosed Prescription Opioid Use Disorders in the United Kingdom , 2017, Pain and Therapy.

[9]  L. Baker,et al.  Association between concurrent use of prescription opioids and benzodiazepines and overdose: retrospective analysis , 2017, British Medical Journal.

[10]  J. Steurer,et al.  Changes over time in prescription practices of pain medications in Switzerland between 2006 and 2013: an analysis of insurance claims , 2017, BMC Health Services Research.

[11]  R. Epstein,et al.  When People with Opioid-Induced Constipation Speak: A Patient Survey , 2017, Advances in Therapy.

[12]  K. Slavin,et al.  Responsible, Safe, and Effective Prescription of Opioids for Chronic Non-Cancer Pain: American Society of Interventional Pain Physicians (ASIPP) Guidelines. , 2017, Pain physician.

[13]  J. Pérez-Cajaraville,et al.  European Pain Federation position paper on appropriate opioid use in chronic pain management , 2016, European journal of pain.

[14]  K. Coyne,et al.  The Burden of Opioid-Induced Constipation: Discordance Between Patient and Health Care Provider Reports , 2016, Journal of managed care & specialty pharmacy.

[15]  M. Camilleri,et al.  Opioid-induced constipation: advances and clinical guidance , 2016, Therapeutic advances in chronic disease.

[16]  T. Zeltner,et al.  Individual Responsibility and Community Solidarity--The Swiss Health Care System. , 2015, The New England journal of medicine.

[17]  P. Bijur,et al.  Naproxen With Cyclobenzaprine, Oxycodone/Acetaminophen, or Placebo for Treating Acute Low Back Pain: A Randomized Clinical Trial. , 2015, JAMA.

[18]  W. Hall,et al.  Benzodiazepine use among chronic pain patients prescribed opioids: associations with pain, physical and mental health, and health service utilization. , 2015, Pain medicine.

[19]  B. Guthrie,et al.  Changes in opioid and other analgesic use 1995–2010: Repeated cross‐sectional analysis of dispensed prescribing for a large geographical population in Scotland , 2015, European journal of pain.

[20]  K. Juel,et al.  Chronic pain, opioid prescriptions, and mortality in Denmark: A population-based cohort study , 2014, PAIN®.

[21]  R. Chou,et al.  Opioid Prescribing: A Systematic Review and Critical Appraisal of Guidelines for Chronic Pain , 2014, Annals of Internal Medicine.

[22]  Sebastian Schneeweiss,et al.  Improved prediction of medical expenditures and health care utilization using an updated chronic disease score and claims data. , 2013, Journal of clinical epidemiology.

[23]  S. Kendall,et al.  Non-analgesic effects of opioids: the cognitive effects of opioids in chronic pain of malignant and non-malignant origin. An update. , 2012, Current pharmaceutical design.

[24]  Laxmaiah Manchikanti,et al.  Opioid epidemic in the United States. , 2012, Pain physician.

[25]  Chia-Hsuin Chang,et al.  Predicting Healthcare Utilization Using a Pharmacy-based Metric With the WHO’s Anatomic Therapeutic Chemical Algorithm , 2011, Medical care.

[26]  C. Rutter,et al.  De Facto Long-term Opioid Therapy for Noncancer Pain , 2008, The Clinical journal of pain.

[27]  E. Bruera,et al.  Critical issues on opioids in chronic non-cancer pain: An epidemiological study , 2006, Pain.

[28]  Bonnie K. Lind,et al.  Challenges of Using Medical Insurance Claims Data for Utilization Analysis , 2006, American journal of medical quality : the official journal of the American College of Medical Quality.

[29]  A. Furlan,et al.  Opioids for chronic noncancer pain: a meta-analysis of effectiveness and side effects , 2006, Canadian Medical Association Journal.

[30]  Paul A. Fishman,et al.  Risk Adjustment Using Automated Ambulatory Pharmacy Data: The RxRisk Model , 2003, Medical care.

[31]  Michael J. Goodman,et al.  Chronic Disease Score as a Predictor of Hospitalization , 2002, Epidemiology.

[32]  H. Sutton.  AN EPIDEMIOLOGICAL STUDY , 1937 .

[33]  M. Suter,et al.  Consommation d’opioïdes entre 1985 et 2015 : chiffres suisses et mise en perspective internationale , 2018, Revue Médicale Suisse.

[34]  J. V. van Amsterdam,et al.  The Misuse of Prescription Opioids: A Threat for Europe? , 2015, Current drug abuse reviews.

[35]  L. Manchikanti,et al.  Opioids in chronic noncancer pain: have we reached a boiling point yet? , 2014, Pain physician.

[36]  R Core Team,et al.  R: A language and environment for statistical computing. , 2014 .

[37]  Howard S. Smith,et al.  American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: Part I--evidence assessment. , 2012, Pain physician.