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Defined daily doses (DDD) do not accurately reflect opioid doses used in contemporary chronic pain treatment
Author(s) -
Nielsen Suzanne,
Gisev Natasa,
Bruno Raimondo,
Hall Wayne,
Cohen Milton,
Larance Briony,
Campbell Gabrielle,
Shanahan Marian,
Blyth Fiona,
Lintzeris Nicholas,
Pearson Sallie,
Mattick Richard,
Degenhardt Louisa
Publication year - 2017
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/pds.4168
Subject(s) - medicine , oxycodone , opioid , hydromorphone , defined daily dose , chronic pain , methadone , tramadol , morphine , cancer pain , buprenorphine , fentanyl , population , anesthesia , analgesic , pharmacology , drug , physical therapy , cancer , receptor , environmental health
Objective To assess how well the defined daily dose (DDD) metric reflects opioid utilisation among chronic non‐cancer pain patients. Design Descriptive, cross‐sectional study, utilising a 7‐day medication diary. Setting Community‐based treatment settings, Australia. Subjects A sample of 1101 people prescribed opioids for chronic non‐cancer pain. Methods Opioid dose data was collected via a self‐completed 7‐day medication diary capturing names, strengths and doses of each medication taken in the past week. Median daily dose was calculated for each opioid. Comparisons were made to the World Health Organization's (WHO) DDD metric. Results WHO DDDs ranged from 0.6 to 7.1 times the median opioid doses used by the sample. For transdermal fentanyl and oral hydromorphone, the median dose was comparable with the DDD. The DDD for methadone was 0.6 times lower than the median doses used by this sample of chronic pain patients. In contrast, the DDD for oxycodone and transdermal buprenorphine, the most commonly used strong opioids for chronic pain in Australia, was two to seven times higher than actual doses used. Conclusions For many opioids, there are key differences between the actual doses used in clinical practice and the WHO's DDDs. The interpretation of opioid utilisation studies using population‐level DDDs may be limited, and a recalibration of the DDD for many opioids or the reporting of opioid utilisation in oral morphine equivalent doses is recommended. Copyright © 2017 John Wiley & Sons, Ltd.