Opioid prescribing among new users for non-cancer pain in the USA, Canada, UK, and Taiwan: A population-based cohort study.

<h4>Background</h4>The opioid epidemic in North America has been driven by an increase in the use and potency of prescription opioids, with ensuing excessive opioid-related deaths. Internationally, there are lower rates of opioid-related mortality, possibly because of differences in pres...

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Autores principales:	Meghna Jani, Nadyne Girard, David W Bates, David L Buckeridge, Therese Sheppard, Jack Li, Usman Iqbal, Shelly Vik, Colin Weaver, Judy Seidel, William G Dixon, Robyn Tamblyn
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/e68fe306b58640a49b2985a336c73ac6
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spelling	oai:doaj.org-article:e68fe306b58640a49b2985a336c73ac62021-12-02T19:55:59ZOpioid prescribing among new users for non-cancer pain in the USA, Canada, UK, and Taiwan: A population-based cohort study.1549-12771549-167610.1371/journal.pmed.1003829https://doaj.org/article/e68fe306b58640a49b2985a336c73ac62021-11-01T00:00:00Zhttps://doi.org/10.1371/journal.pmed.1003829https://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>The opioid epidemic in North America has been driven by an increase in the use and potency of prescription opioids, with ensuing excessive opioid-related deaths. Internationally, there are lower rates of opioid-related mortality, possibly because of differences in prescribing and health system policies. Our aim was to compare opioid prescribing rates in patients without cancer, across 5 centers in 4 countries. In addition, we evaluated differences in the type, strength, and starting dose of medication and whether these characteristics changed over time.<h4>Methods and findings</h4>We conducted a retrospective multicenter cohort study of adults who are new users of opioids without prior cancer. Electronic health records and administrative health records from Boston (United States), Quebec and Alberta (Canada), United Kingdom, and Taiwan were used to identify patients between 2006 and 2015. Standard dosages in morphine milligram equivalents (MMEs) were calculated according to The Centers for Disease Control and Prevention. Age- and sex-standardized opioid prescribing rates were calculated for each jurisdiction. Of the 2,542,890 patients included, 44,690 were from Boston (US), 1,420,136 Alberta, 26,871 Quebec (Canada), 1,012,939 UK, and 38,254 Taiwan. The highest standardized opioid prescribing rates in 2014 were observed in Alberta at 66/1,000 persons compared to 52, 51, and 18/1,000 in the UK, US, and Quebec, respectively. The median MME/day (IQR) at initiation was highest in Boston at 38 (20 to 45); followed by Quebec, 27 (18 to 43); Alberta, 23 (9 to 38); UK, 12 (7 to 20); and Taiwan, 8 (4 to 11). Oxycodone was the first prescribed opioid in 65% of patients in the US cohort compared to 14% in Quebec, 4% in Alberta, 0.1% in the UK, and none in Taiwan. One of the limitations was that data were not available from all centers for the entirety of the 10-year period.<h4>Conclusions</h4>In this study, we observed substantial differences in opioid prescribing practices for non-cancer pain between jurisdictions. The preference to start patients on higher MME/day and more potent opioids in North America may be a contributing cause to the opioid epidemic.Meghna JaniNadyne GirardDavid W BatesDavid L BuckeridgeTherese SheppardJack LiUsman IqbalShelly VikColin WeaverJudy SeidelWilliam G DixonRobyn TamblynPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 18, Iss 11, p e1003829 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Meghna Jani Nadyne Girard David W Bates David L Buckeridge Therese Sheppard Jack Li Usman Iqbal Shelly Vik Colin Weaver Judy Seidel William G Dixon Robyn Tamblyn Opioid prescribing among new users for non-cancer pain in the USA, Canada, UK, and Taiwan: A population-based cohort study.
description	<h4>Background</h4>The opioid epidemic in North America has been driven by an increase in the use and potency of prescription opioids, with ensuing excessive opioid-related deaths. Internationally, there are lower rates of opioid-related mortality, possibly because of differences in prescribing and health system policies. Our aim was to compare opioid prescribing rates in patients without cancer, across 5 centers in 4 countries. In addition, we evaluated differences in the type, strength, and starting dose of medication and whether these characteristics changed over time.<h4>Methods and findings</h4>We conducted a retrospective multicenter cohort study of adults who are new users of opioids without prior cancer. Electronic health records and administrative health records from Boston (United States), Quebec and Alberta (Canada), United Kingdom, and Taiwan were used to identify patients between 2006 and 2015. Standard dosages in morphine milligram equivalents (MMEs) were calculated according to The Centers for Disease Control and Prevention. Age- and sex-standardized opioid prescribing rates were calculated for each jurisdiction. Of the 2,542,890 patients included, 44,690 were from Boston (US), 1,420,136 Alberta, 26,871 Quebec (Canada), 1,012,939 UK, and 38,254 Taiwan. The highest standardized opioid prescribing rates in 2014 were observed in Alberta at 66/1,000 persons compared to 52, 51, and 18/1,000 in the UK, US, and Quebec, respectively. The median MME/day (IQR) at initiation was highest in Boston at 38 (20 to 45); followed by Quebec, 27 (18 to 43); Alberta, 23 (9 to 38); UK, 12 (7 to 20); and Taiwan, 8 (4 to 11). Oxycodone was the first prescribed opioid in 65% of patients in the US cohort compared to 14% in Quebec, 4% in Alberta, 0.1% in the UK, and none in Taiwan. One of the limitations was that data were not available from all centers for the entirety of the 10-year period.<h4>Conclusions</h4>In this study, we observed substantial differences in opioid prescribing practices for non-cancer pain between jurisdictions. The preference to start patients on higher MME/day and more potent opioids in North America may be a contributing cause to the opioid epidemic.
format	article
author	Meghna Jani Nadyne Girard David W Bates David L Buckeridge Therese Sheppard Jack Li Usman Iqbal Shelly Vik Colin Weaver Judy Seidel William G Dixon Robyn Tamblyn
author_facet	Meghna Jani Nadyne Girard David W Bates David L Buckeridge Therese Sheppard Jack Li Usman Iqbal Shelly Vik Colin Weaver Judy Seidel William G Dixon Robyn Tamblyn
author_sort	Meghna Jani
title	Opioid prescribing among new users for non-cancer pain in the USA, Canada, UK, and Taiwan: A population-based cohort study.
title_short	Opioid prescribing among new users for non-cancer pain in the USA, Canada, UK, and Taiwan: A population-based cohort study.
title_full	Opioid prescribing among new users for non-cancer pain in the USA, Canada, UK, and Taiwan: A population-based cohort study.
title_fullStr	Opioid prescribing among new users for non-cancer pain in the USA, Canada, UK, and Taiwan: A population-based cohort study.
title_full_unstemmed	Opioid prescribing among new users for non-cancer pain in the USA, Canada, UK, and Taiwan: A population-based cohort study.
title_sort	opioid prescribing among new users for non-cancer pain in the usa, canada, uk, and taiwan: a population-based cohort study.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/e68fe306b58640a49b2985a336c73ac6
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Opioid prescribing among new users for non-cancer pain in the USA, Canada, UK, and Taiwan: A population-based cohort study.

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