Treish Imad M, Hammoudeh Suzan S, Salmany Sewar S, Al-Kharabsheh Asma'a, Jaddoua Saad, Haqaish Wesal S, Al-Ruzzieh Majeda A, Shamieh Omar
Department of Pharmacy (I.M.T., S.S.H., S.S.S., A.A., S.J.), King Hussein Cancer Center, Amman, Jordan; Division of Strategic Affairs, King Hussein Cancer Center, Amman, Jordan.
Department of Pharmacy (I.M.T., S.S.H., S.S.S., A.A., S.J.), King Hussein Cancer Center, Amman, Jordan.
J Pain Symptom Manage. 2022 May;63(5):e481-e487. doi: 10.1016/j.jpainsymman.2022.01.001. Epub 2022 Jan 10.
The International Narcotics Control Board's (INCB) opioids consumption data are often cited in the literature and by policy makers to benchmark the adequacy of pain management among different countries. This practice may be inaccurate as INCB data does not account for variations in disease burden and use of other pain medications and only controls for population sizes differences among countries.
To demonstrate that INCB consumption data may not be an accurate/sensitive indicator for pain management adequacy due to significant inter-country variations in disease burden and in the use of pain medications that are not reported by INCB.
We compared opioid consumption data between 2012 and 2016 for Jordan and King Hussein Cancer Center vs five high-income countries (United States of America, United Kingdom, France, Sweden, and Japan) taking into consideration the cancer burden in those countries. In addition, we examined the significance of tramadol utilization in the setting of cancer pain management.
Jordan's INCB-reported opioid consumption is ostensibly low at a median of 291 sDDD/million inhabitants/day. Compared to Jordan, the median consumption in the five HICs is 34 (range 4-172) times that of Jordan. However, when consumption is adjusted to cancer burden data, the gap is significantly reduced to a median of 2 (range 0.2-24) times that of Jordan and in the case of one institution's experience, the gap is eliminated. Furthermore, Jordan's tramadol's median consumption between 2012-2016 of 176 kg is equivalent to 127% of morphine consumption on an equianalgesic basis.
INCB data should not be utilized to benchmark the adequacy of pain management among different countries without taking into consideration variations in disease burden and the use of tramadol and other pain drugs.
国际麻醉品管制局（INCB）的阿片类药物消费数据经常被文献和政策制定者引用，以衡量不同国家疼痛管理的充分程度。这种做法可能不准确，因为INCB数据没有考虑疾病负担的差异和其他止痛药物的使用情况，仅控制了各国之间的人口规模差异。
证明由于各国疾病负担和INCB未报告的止痛药物使用存在显著差异，INCB消费数据可能不是衡量疼痛管理充分程度的准确/敏感指标。
我们比较了2012年至2016年约旦和侯赛因国王癌症中心与五个高收入国家（美利坚合众国、英国、法国、瑞典和日本）的阿片类药物消费数据，同时考虑了这些国家的癌症负担。此外，我们研究了曲马多在癌症疼痛管理中的使用意义。
INCB报告的约旦阿片类药物消费表面上较低，中位数为291标准限定日剂量/百万居民/天。与约旦相比，五个高收入国家的中位数消费量是约旦的34倍（范围为4至172倍）。然而，当根据癌症负担数据调整消费量时，差距显著缩小至约旦的中位数2倍（范围为0.2至24倍），就一个机构的情况而言，差距消除。此外，约旦在2012 - 2016年期间曲马多的中位数消费量为176千克，按等效镇痛剂量计算相当于吗啡消费量的127%。
在不考虑疾病负担差异以及曲马多和其他止痛药物使用情况时不应使用INCB数据来衡量不同国家疼痛管理的充分程度。
