Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary.
Central Pharmacy Department, Albert Szent-Györgyi Health Center, University of Szeged, Szeged, Hungary.
Eur J Pain. 2022 Oct;26(9):1896-1909. doi: 10.1002/ejp.2011. Epub 2022 Aug 12.
Opioid use is well documented in several countries: some countries struggle with overuse, whereas others have almost no access to opioids. For Europe, limited data are available. This study analysed Hungarian opioid utilization in ambulatory care between 2006 and 2020.
We obtained national drug utilization data on reimbursed opioid analgesics (ATC code: N02A) from a national health insurance database for a 15-year period. We investigated utilization trends, using three volume-based metrics [defined daily dose per 1000 inhabitants per day (DID), oral morphine equivalent per 1000 inhabitants per day, packages dispensed per 1000 inhabitants per year]. We stratified data based on administration routes, analgesic potency and reimbursement categories.
Total opioid utilization increased during the study period according to all three metrics (74% in DID) and reached 5.31 DID by 2020. Upward trends were driven by an increase both in weak and strong opioid use (79% vs. 53%). The most commonly used opioids were fentanyl (in the strong category; 0.76 DID in 2020) and tramadol (in the weak category; 2.62 DID in 2020). Overall, tramadol was also the most commonly used opioid throughout the study period. Oral administration of opioid medications was dominant. Based on reimbursement categories, musculoskeletal pain was becoming a more frequent indication for opioid use (1552% increase in DID), while opioid use for cancer pain declined significantly during the study period (-33% in DID).
Our low utilization numbers might indicate underuse of opioid analgesia, especially for cancer pain.
This study was one of the recent opioid utilization studies using three volume-based metrics, covering a long time period. To our knowledge, this was also the first national, population level study describing opioid utilization in Hungary. National opioid utilization data suggested not an overuse but rather an underuse of opioid analgesics in a developed, Central European country.
阿片类药物的使用在许多国家都有记载：一些国家存在滥用问题，而另一些国家则几乎无法获得阿片类药物。对于欧洲，可用的数据有限。本研究分析了 2006 年至 2020 年期间匈牙利在门诊护理中阿片类药物的使用情况。
我们从国家健康保险数据库中获得了 15 年来国家药物使用数据，涵盖报销的阿片类镇痛药（ATC 代码：N02A）。我们使用三种基于数量的指标[每 1000 名居民每天的定义日剂量（DID）、每 1000 名居民每天的口服吗啡当量、每年每 1000 名居民分发的包装]来调查使用趋势。我们根据给药途径、镇痛效力和报销类别对数据进行分层。
根据所有三种指标（DID 增加 74%），研究期间阿片类药物的总使用量均有所增加，并在 2020 年达到 5.31 DID。这种上升趋势是由弱阿片类药物和强阿片类药物使用的增加（79%比 53%）驱动的。最常用的阿片类药物是芬太尼（强效类；2020 年为 0.76 DID）和曲马多（弱效类；2020 年为 2.62 DID）。总体而言，曲马多在整个研究期间也是最常用的阿片类药物。阿片类药物的口服给药方式占主导地位。根据报销类别，肌肉骨骼疼痛成为阿片类药物使用的更常见指征（DID 增加 1552%），而癌症疼痛的阿片类药物使用在研究期间显著下降（DID 减少 33%）。
我们的低使用量可能表明阿片类药物镇痛剂的使用不足，尤其是癌症疼痛。
本研究是使用三种基于数量的指标进行的最近的阿片类药物使用研究之一，涵盖了很长一段时间。据我们所知，这也是首次在匈牙利进行的全国性、人群水平的阿片类药物使用研究。国家阿片类药物使用数据表明，在一个发达的中欧国家，阿片类药物镇痛剂的使用不是过度，而是不足。
