Pain physician · 2019
Opioid Prescription in Switzerland: Appropriate Comedication use in Cancer and Noncancer Pain.
СтатьяНазвание и аннотация: Перевод в очереди
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Wertli Maria M, Held Ulrike, Signorell Andri, Steurer Johann, Blozik Eva, Burgstaller Jakob M
Аннотация
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.
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.