Impact of expanded strong opioid availability on opioid prescription patterns in patients with cancer: A population-wide cohort study in Taiwan

Background One of the major barriers to adequate cancer pain management in Taiwan is the limited prescription options regarding strong opioids. Internationally recommended strong opioids, including oxycodone and hydromorphone, were not introduced in Taiwan until late 2014. We analysed the patterns i...

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Autores principales:	Tsung-Che Wu, Chih-Hung Hsu, Wei-Zen Sun, Ho-Min Chen, Chih-Peng Lin, Yu-Yun Shao
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Cancer pain Opioids Transdermal fentanyl Hydromorphone Oxycodone Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/c67e1fd9e82d43898be16536bb65b79b
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spelling	oai:doaj.org-article:c67e1fd9e82d43898be16536bb65b79b2021-12-02T05:04:01ZImpact of expanded strong opioid availability on opioid prescription patterns in patients with cancer: A population-wide cohort study in Taiwan2666-606510.1016/j.lanwpc.2021.100255https://doaj.org/article/c67e1fd9e82d43898be16536bb65b79b2021-11-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2666606521001644https://doaj.org/toc/2666-6065Background One of the major barriers to adequate cancer pain management in Taiwan is the limited prescription options regarding strong opioids. Internationally recommended strong opioids, including oxycodone and hydromorphone, were not introduced in Taiwan until late 2014. We analysed the patterns in opioid prescription for cancer pain management, after the introduction of new opioid options.Methods All inpatient and outpatient clinical visits from January 1, 2012, to December 31, 2017, with the diagnosis of cancer and the analgesic prescriptions were collected from the database of National Health Insurance, Taiwan, and analysed. Opioids were grouped into strong opioids, weak opioids, and guideline non-recommended opioids.Findings A total of 1, 292, 905 patients with cancers were included. Approximately 50% of patients used analgesics, 50% of which were opioids; the proportions were stable during the study period. The annual cumulative opioid use per patient (defined daily dose, DDD) significantly decreased from 36•41±102•59 (Mean±SD) in 2012 to 32•42±100•99 in 2017 (p < •001). The annual cumulative strong opioid use per patient increased significantly from 17•54±89•23 in 2012 to 19•28±94•97 in 2017 (+9•90%, p < •001). In parallel, the annual cumulative weak opioids use per patient decreased from 18•64±40•81 in 2012 to 13•04±26•79 in 2017 (−30•04%, p < •001). Among extended-release strong opioids, the use of transdermal fentanyl significantly decreased after oxycodone and hydromorphone were introduced (p < •001).Interpretation Increased therapeutic options in strong opioid prescriptions led opioid prescription patterns to evolve towards international cancer pain management guidelines. In addition, increased accessibility to a wider range of different strong opioids may facilitate more efficient opioid titration and rotation - and thus decrease, not increase, the opioid usage.Funding This study was supported by Ministry of Science and Technology, Taiwan (MOST-106-2314-B-002-213 and MOST-108-2314-B-002-072-MY3), Ministry of Health and Welfare, Taiwan (MOHW109-TDU-B-211-114002), National Taiwan University Hospital, Taipei, Taiwan (NTUH-103-002314 and NTUH. 105‐S2954), and National Center of Excellence for Clinical Trial & Research, National Taiwan University Hospital, Taipei, Taiwan (NCTRC201208 and NCTRC201603).Tsung-Che WuChih-Hung HsuWei-Zen SunHo-Min ChenChih-Peng LinYu-Yun ShaoElsevierarticleCancer painOpioidsTransdermal fentanylHydromorphoneOxycodonePublic aspects of medicineRA1-1270ENThe Lancet Regional Health. Western Pacific, Vol 16, Iss , Pp 100255- (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Cancer pain Opioids Transdermal fentanyl Hydromorphone Oxycodone Public aspects of medicine RA1-1270
spellingShingle	Cancer pain Opioids Transdermal fentanyl Hydromorphone Oxycodone Public aspects of medicine RA1-1270 Tsung-Che Wu Chih-Hung Hsu Wei-Zen Sun Ho-Min Chen Chih-Peng Lin Yu-Yun Shao Impact of expanded strong opioid availability on opioid prescription patterns in patients with cancer: A population-wide cohort study in Taiwan
description	Background One of the major barriers to adequate cancer pain management in Taiwan is the limited prescription options regarding strong opioids. Internationally recommended strong opioids, including oxycodone and hydromorphone, were not introduced in Taiwan until late 2014. We analysed the patterns in opioid prescription for cancer pain management, after the introduction of new opioid options.Methods All inpatient and outpatient clinical visits from January 1, 2012, to December 31, 2017, with the diagnosis of cancer and the analgesic prescriptions were collected from the database of National Health Insurance, Taiwan, and analysed. Opioids were grouped into strong opioids, weak opioids, and guideline non-recommended opioids.Findings A total of 1, 292, 905 patients with cancers were included. Approximately 50% of patients used analgesics, 50% of which were opioids; the proportions were stable during the study period. The annual cumulative opioid use per patient (defined daily dose, DDD) significantly decreased from 36•41±102•59 (Mean±SD) in 2012 to 32•42±100•99 in 2017 (p < •001). The annual cumulative strong opioid use per patient increased significantly from 17•54±89•23 in 2012 to 19•28±94•97 in 2017 (+9•90%, p < •001). In parallel, the annual cumulative weak opioids use per patient decreased from 18•64±40•81 in 2012 to 13•04±26•79 in 2017 (−30•04%, p < •001). Among extended-release strong opioids, the use of transdermal fentanyl significantly decreased after oxycodone and hydromorphone were introduced (p < •001).Interpretation Increased therapeutic options in strong opioid prescriptions led opioid prescription patterns to evolve towards international cancer pain management guidelines. In addition, increased accessibility to a wider range of different strong opioids may facilitate more efficient opioid titration and rotation - and thus decrease, not increase, the opioid usage.Funding This study was supported by Ministry of Science and Technology, Taiwan (MOST-106-2314-B-002-213 and MOST-108-2314-B-002-072-MY3), Ministry of Health and Welfare, Taiwan (MOHW109-TDU-B-211-114002), National Taiwan University Hospital, Taipei, Taiwan (NTUH-103-002314 and NTUH. 105‐S2954), and National Center of Excellence for Clinical Trial & Research, National Taiwan University Hospital, Taipei, Taiwan (NCTRC201208 and NCTRC201603).
format	article
author	Tsung-Che Wu Chih-Hung Hsu Wei-Zen Sun Ho-Min Chen Chih-Peng Lin Yu-Yun Shao
author_facet	Tsung-Che Wu Chih-Hung Hsu Wei-Zen Sun Ho-Min Chen Chih-Peng Lin Yu-Yun Shao
author_sort	Tsung-Che Wu
title	Impact of expanded strong opioid availability on opioid prescription patterns in patients with cancer: A population-wide cohort study in Taiwan
title_short	Impact of expanded strong opioid availability on opioid prescription patterns in patients with cancer: A population-wide cohort study in Taiwan
title_full	Impact of expanded strong opioid availability on opioid prescription patterns in patients with cancer: A population-wide cohort study in Taiwan
title_fullStr	Impact of expanded strong opioid availability on opioid prescription patterns in patients with cancer: A population-wide cohort study in Taiwan
title_full_unstemmed	Impact of expanded strong opioid availability on opioid prescription patterns in patients with cancer: A population-wide cohort study in Taiwan
title_sort	impact of expanded strong opioid availability on opioid prescription patterns in patients with cancer: a population-wide cohort study in taiwan
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/c67e1fd9e82d43898be16536bb65b79b
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Impact of expanded strong opioid availability on opioid prescription patterns in patients with cancer: A population-wide cohort study in Taiwan

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