Predicting the long term effects and the risks of abuse and misuse in long term opioid users with chronic non-cancer pain

Zin, Che Suraya (2019) Predicting the long term effects and the risks of abuse and misuse in long term opioid users with chronic non-cancer pain. Project Report. UNSPECIFIED, Kuantan. (Unpublished)

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Abstract

Little is known about the patterns of analgesic prescribing particularly on opioid prescribing in Malaysia. The issue related to persistence and adherence to opioid therapy is unclear and whether the initial characteristics of opioid prescribing influence the long term use of opioids is also unknown. Objectives This study examined the trends of analgesic prescribing at public tertiary hospital outpatient settings and explore the patterns of their utilization in NSAIDs, tramadol and opioid patients. Also examined opioid prescription initiation patterns and their association with short- and long-term opioid use among opioid-naïve patients. Exploration on the different patterns of persistent opioid use and the change in these patterns over time in patients with non-cancer and cancer pain also include Methods This retrospective cross sectional study was conducted from 2010 to 2016 using the prescription databases of two tertiary hospitals in Malaysia. Prescriptions for nine NSAIDs (ketoprofen, diclofenac, celecoxib, etoricoxib, ibuprofen, indomethacin, meloxicam, mefenamic acid and naproxen), tramadol and five other opioids (morphine, fentanyl, oxycodone, dihydrocodeine, and buprenorphine) were included in this study. Annual number of patients and prescriptions were measured in repeat cross sectional estimates. For the characteristics of initial opioid prescribing, this study included patients aged ≥18 years with at least one opioid prescription. These patients had no opioid prescriptions in the 365 days prior, and were followed-up for 365 days after the initial opioid prescription. The main outcome measures were the number of short-term (<90 days) and long-term opioid users (≥90 days), initial opioid prescription period, and daily dose. To explore the persistence in opioid use, a three-dimensional persistence measure consisting of treatment intensity, frequency and distribution were used to define persistent opioid users as wide (use opioids most of the days in a year), intermediate (use opioids daily) or strict (use opioids continuously to achieve a therapeutic concentration) users. The number of patients in each persistence definition and the change in persistence patterns over time was recorded. Results A total of 192747 analgesic prescriptions of the nine NSAIDs, tramadol, and five other opioids were prescribed for 97227 patients (51.8% NSAIDs patients, 46.6% tramadol patients, and 1.7% opioid patients) from 2010 to 2016. Tramadol (37.9%, n = 72999) was the most frequently prescribed analgesic followed by ketoprofen (17.5%, n=33793), diclofenac (16.2%, n = 31180), celecoxib (12.2%, n =23487), and other NSAIDs (<4.5%). Characteristics of initial opioid prescribing showed that the majority of these short- (99.09%) and long-term users (96.18%) received an initial daily opioid dose of <50 mg/day with a short-acting opioid formulation. Short-term opioid users were predominantly prescribed opioids for 3-7 days (59.06%) by the emergency department (ED, 60.56%), while long-term opioid users were primarily prescribed opioids for ≥7 days (91.85%) by non-ED hospital departments (91.8%). The adjusted model showed that the following were associated with long-term opioid use: increasing opioid daily doses, prescription period ≥7 days, and long-acting opioids initiated by non-EDs. Exploration on persistence demonstrated that majority of persistent opioid users in the non-cancer and cancer groups were in the wide (9.3% vs.4.8%), followed by intermediate (3.1% vs.0.5%), and strict (1.8% vs.0.9%) definitions. Over a three-year study duration, change to a less stringent persistence definition was observed in the non-cancer group whereas no discernible pattern of change was observed in the cancer group. Conclusions Tramadol was the most frequently prescribed analgesic at hospital outpatient settings in Malaysia. Opioids were prescribed the least but noted the highest increase in utilization. The majority of opioid-naïve patients in tertiary hospital settings in Malaysia were prescribed opioids for short-term use. The progression to long-term use among opioid-naïve patients was attributed to the prescription of higher opioid doses for a longer duration as well as long-acting opioids initiated by non-emergency department (ED) hospital departments. Change in the patterns of clinical opioid use over time was detected among persistent opioid users in both non-cancer and cancer groups using a three-dimensional persistence measure. This measure which is sensitive to the changes in clinical use of opioids over time can greatly impact future research and practices for better pain management involving opioids

Item Type:	Monograph (Project Report)
Additional Information:	4127/73550
Uncontrolled Keywords:	Trends of prescribing, patterns, analgesics, tramadol, NSAIDs, opioids Initial opioid prescription; opioid-naïve; opioid prescribing; Malaysia cancer pain, persistence patterns, non-cancer pain
Subjects:	R Medicine > RM Therapeutics. Pharmacology R Medicine > RM Therapeutics. Pharmacology > RM147 Administration of Drugs and Other Therapeutic Agents
Kulliyyahs/Centres/Divisions/Institutes (Can select more than one option. Press CONTROL button):	Kulliyyah of Pharmacy > Department of Pharmacy Practice Kulliyyah of Pharmacy
Depositing User:	Prof Dr Che Suraya Mohd Zin
Date Deposited:	26 Aug 2019 11:34
Last Modified:	26 Aug 2019 11:34
URI:	http://irep.iium.edu.my/id/eprint/73550

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