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Tramadol use in Norway: A register‐based population study
Author(s) -
Birke Hanne,
Ekholm Ola,
Sjøgren Per,
Fredheim Olav,
Clausen Thomas,
Skurtveit Svetlana
Publication year - 2019
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.4626
Subject(s) - tramadol , medicine , opioid , medical prescription , pharmacoepidemiology , defined daily dose , population , norwegian , anesthesia , emergency medicine , pharmacology , analgesic , environmental health , linguistics , philosophy , receptor
Purpose Increasing use of tramadol for chronic non‐cancer pain is concerning since tramadol users may be at risk of developing recurrent opioid use with increasing opioid consumption and co‐medication. Therefore, we investigated a complete national cohort of tramadol users. Methods The study population (154 042 adult individuals in Norway, who redeemed ≥ one tramadol prescription in 2012) was stratified into four groups according to their opioid use 2 years before their first tramadol prescription in 2012 and followed until 2016. Information on all dispensed opioid analgesics, benzodiazepines (BZDs), and BZD‐related Z‐hypnotics were retrieved from the Norwegian Prescription Database. Results Six percent of opioid naïve tramadol users (no opioid use 2 years before tramadol use in 2012) became recurrent users (received opioids annually during 4‐year follow‐up), almost doubled their mean opioid consumption (66 to 108 defined daily doses [DDD]). One‐quarter proceeded to strong opioids or was co‐medicated with BZDs, one‐third with Z‐hypnotics. Among former weak opioid users, 39.8% became recurrent users, 18.7% proceeded to strong opioids, mean opioid consumption increased slightly, one‐third used BZDs, or Z‐hypnotics concurrently. Among former strong opioid and users in palliative care; 61%, 70% became recurrent users and developed a similar prescription pattern (high and increasing mean opioid consumption, 301 to 318, 413 to 430 DDD); half of them proceeded to strong opioids and/or used BZDs or Z‐hypnotics concurrently. Conclusions Many patients who developed recurrent opioid use received prescriptions which substantially conflicted with existing guidelines and might lead to problematic opioid use.