Oliva Alexis, González de Chavez Patricia, Dévora Sandra, Abdala Susana
Departamento de Ingeniería Química y Tecnología Farmacéutica, Facultad de Farmacia, Universidad de La Laguna, Tenerife, Spain.
Departamento de Medicina Física y Farmacología, Facultad de Farmacia, Universidad de La Laguna, Tenerife, Spain.
Front Pharmacol. 2023 Jul 18;14:1184457. doi: 10.3389/fphar.2023.1184457. eCollection 2023.
The use of opioids has increased markedly in the past decades in European countries, especially for treatment of non-cancer pain including painful chronic musculoskeletal conditions. However, there are some notable differences in the relative levels of use between geographical areas and some distinct, context-specific patterns of weak and strong opioid use. The aim of this work is to describe real world trends in dosage forms and population exposure in the prescription opioid use on isolated geographically area: The Canary Islands of Gran Canaria, Lanzarote and Fuerteventura, Spain. For this, several factors such as living in a rural or urban area, population over 65 years of age, population density or socioeconomic status were analyzed. Data were extracted from the wholesalers who supply the community pharmacies at the population level. Prescription opioid use was measured as defined daily doses (DDD) per 1,000 inhabitants per day. A model based on covariance analysis with two nested fixed factors and one co-variable was used for contrast analysis at different level. The overall DDD per 1000 inhabitants per day and year variation rate in Spain was very similar to that obtained for Gran Canaria and Fuerteventura (0.967 vs. 1.006), although the levels of dispensation were different (14.75 18.24 for Gran Canaria and 12.7 for Fuerteventura, respectively). Lanzarote is completely different in all issues, where the opioid consumption rate remained stable during the study period, but with a decreasing tendency. The dispensation level of strong opioids varied between islands, from 56.41% for Fuerteventura vs. 17.61% for Gran Canaria, although these values remained stable. Tramadol with acetaminophen and Tramadol in monotherapy were the most consumed forms of the weak opioids, whereas Buprenorphine was the most used strong opioid followed by Fentanyl, although demand for it varied between islands, the transdermal formulations were the most frequent pharmaceutical preparation. The differences in prescription opioid use are most likely explained by the opioid prescribing practices in each island, whereas factors such urbanicity level, population age, population density and status socioeconomic does not help to explain the differences in prescription opioid use across rural and urban areas.
在过去几十年里，欧洲国家阿片类药物的使用显著增加，尤其是用于治疗非癌性疼痛，包括慢性肌肉骨骼疼痛。然而，不同地理区域之间的相对使用水平存在一些显著差异，并且存在一些独特的、因地制宜的弱阿片类药物和强阿片类药物使用模式。这项工作的目的是描述西班牙大加那利岛、兰萨罗特岛和富埃特文图拉岛等地理区域孤立地区处方阿片类药物使用中剂型和人群暴露的实际趋势。为此，分析了几个因素，如生活在农村或城市地区、65岁以上人口、人口密度或社会经济地位。数据是从在人群层面为社区药房供货的批发商处提取的。处方阿片类药物的使用以每千居民每天的限定日剂量（DDD）来衡量。使用了一个基于协方差分析的模型，该模型有两个嵌套固定因素和一个协变量，用于不同层面的对比分析。西班牙每千居民每天的总体DDD和年变化率与大加那利岛和富埃特文图拉岛获得的非常相似（分别为0.967和1.006），尽管配药水平不同（大加那利岛为14.75，富埃特文图拉岛为18.24，富埃特文图拉岛为12.7）。兰萨罗特岛在所有方面都完全不同，在研究期间其阿片类药物消费率保持稳定，但呈下降趋势。强阿片类药物的配药水平在各岛屿之间有所不同，富埃特文图拉岛为56.41%，而大加那利岛为17.61%，尽管这些值保持稳定。对乙酰氨基酚曲马多和单一疗法中的曲马多是弱阿片类药物中消费最多的剂型，而丁丙诺啡是使用最多的强阿片类药物，其次是芬太尼，尽管各岛屿对其需求不同，透皮制剂是最常见的药物制剂。各岛屿处方阿片类药物使用的差异很可能是由每个岛屿的阿片类药物处方习惯造成的，而诸如城市化水平、人口年龄、人口密度和社会经济地位等因素并不能解释农村和城市地区处方阿片类药物使用的差异。
