[Trend in opioids use for chronic pain treatment at Clalit Health Services (2000-2004)]

Tami Freud, Silviu Brill, Michael Sherf, Yoram Singer, Daniel Vardy, Pesach Shvartzman
Harefuah 2007, 146 (12): 928-31, 999

BACKGROUND: Opioids are considered a cornerstone in the treatment of cancer and non-cancer pain. The World Health Organization considers a country's morphine consumption to be an important indicator of the quality of pain control. There is little or no use of opioids in nearly half of the countries in the world.

OBJECTIVE: To assess the change in trends of opioids use for chronic pain treatment over a period of five years (2000-2004) among members of Clalit Health Services (CHS) in Israel.

METHOD: Data on the consumption of opioid analgesic drugs that were authorized for use in Israel during the years 2000-2004 were obtained from the computerized data bases of CHS. In addition, patient's demographic details and cancer morbidity were also extracted. To make the patient's use of opioids comparable, we analyzed the data by translating all opioids consumption (fentanyl patch, oxycodone, methadone, hydromorphone) to oral morphine equivalents.

RESULTS: An increase of 68% in total morphine consumption was found between the years 2000 and 2004 (from 56.4 Kg to 94.9 Kg) and in mg morphine per prescription from 15.7 to 25.3 mg. The total amount of morphine per prescription increased from 834.2 mg to 892.9 mg. The total number of patients who received an opioid prescription multiplied by 1.47 (from 18,551 to 27,302) while the growth in total number of CHS members was significantly smaller. No significant differences were found during the years in the characteristics of patients who received opioids; regarding gender (58% were woman) and age (about 80% were 65 years old and above). During the year 2004, a preliminary examination of opioids consumption, comparing cancer and non-cancer pain patients, showed that cancer pain patients used 2.74 times higher dosage than non-cancer pain patients (6110.8 vs. 2225.6 mg/patients/year).

CONCLUSIONS: During the 5 year period evaluated, there is a growing trend in use of opioids at CHS in Israel. This trend may be an indication of the improvement in treatment of chronic pain.

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