Oxycodone and Morphine Use in Hospitals and Primary Care in Norway 2010–2021: A Nationwide Study

IF 3.4 2区 医学 Q1 ANESTHESIOLOGY
Eirik Haarr, Marte Handal, Svetlana Skurtveit, Torgeir Gilje Lid
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引用次数: 0

Abstract

Background

Increasing oxycodone prescribing and its association with opioid-related harms have raised concerns. In Norway, nearly 90% of opioids are prescribed in primary care, making primary care decisions important to overall opioid exposure. In-hospital use may influence primary care practices through several mechanisms. This study analyses oxycodone and morphine use in Norwegian hospitals and its association with primary care prescribing from 2010 to 2021, alongside a review of tender agreements for these medications.

Methods

Morphine and oxycodone, available in all relevant formulations, served as opioid proxies to compare covariation between hospitals and their catchment areas. We analyzed 2010–2021 procurement data from hospital pharmacies and primary care dispensing data from the Norwegian Prescription Database for all hospital trusts. Correlations between hospital and primary care morphine-to-oxycodone prescribing ratios were assessed using Pearson's r. Annual tender agreements were obtained from the national Hospital Procurement Organization.

Results

Hospital oxycodone use increased by 67.0% and primary care prescribing rose by 86.5%. Morphine use increased by 12.6% in hospitals but decreased by 23.2% in primary care. A moderate covariation (Pearson's r = 0.48) between hospital use and primary care prescribing was observed. Hospital tender agreements for morphine declined by 80%, while those for oxycodone remained stable.

Conclusions

Oxycodone use substantially increased relative to morphine in Norwegian hospitals and primary care. Prescription patterns show moderate covariation, suggesting a potential link between hospital and primary care prescribing, though causality remains uncertain. Tender agreements may contribute to prescribing trends in hospitals, with possible associations in primary care.

Significance

This study is the first to provide quantitative evidence of covariation between in-hospital use and primary care opioid prescribing across a national healthcare system. Despite recommendations favoring morphine, oxycodone prescribing continues to rise in Norway, with marked geographical variation. By linking procurement data, prescription patterns and tender agreements, our findings highlight the need to consider hospital practices and structural factors when addressing opioid prescribing. These results offer new insights into potential levers for opioid stewardship across care levels.

2010-2021年挪威医院和初级保健中羟考酮和吗啡的使用:一项全国性研究
越来越多的羟考酮处方及其与阿片类药物相关危害的关联引起了人们的关注。在挪威,近90%的阿片类药物是在初级保健中处方的,这使得初级保健决定对总体阿片类药物暴露很重要。院内使用可通过几种机制影响初级保健实践。本研究分析了2010年至2021年挪威医院羟考酮和吗啡的使用情况及其与初级保健处方的关系,并对这些药物的招标协议进行了审查。方法以吗啡和羟考酮作为阿片类药物的代用指标,比较各医院及其集水区之间的协变。我们分析了2010-2021年来自医院药房的采购数据和挪威处方数据库中所有医院信托的初级保健配药数据。医院和初级保健的吗啡与羟考酮处方比例之间的相关性使用Pearson’s r进行评估。年度招标协议从国家医院采购组织获得。结果医院羟考酮使用量增加67.0%,基层保健处方量增加86.5%。吗啡在医院的使用增加了12.6%,但在初级保健中减少了23.2%。在医院使用和初级保健处方之间观察到中度协变(Pearson’s r = 0.48)。医院对吗啡的招标协议下降了80%,而羟考酮的招标协议保持稳定。结论在挪威医院和初级保健中,羟考酮的使用明显高于吗啡。处方模式显示适度的共变,表明医院和初级保健处方之间存在潜在的联系,尽管因果关系仍不确定。招标协议可能有助于医院的处方趋势,可能与初级保健有关。意义本研究首次提供了全国医疗保健系统中住院使用和初级保健阿片类药物处方之间共变的定量证据。尽管推荐使用吗啡,但挪威的羟考酮处方仍在增加,地域差异明显。通过将采购数据、处方模式和招标协议联系起来,我们的研究结果强调了在处理阿片类药物处方时需要考虑医院实践和结构因素。这些结果为整个护理水平的阿片类药物管理的潜在杠杆提供了新的见解。
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来源期刊
European Journal of Pain
European Journal of Pain 医学-临床神经学
CiteScore
7.50
自引率
5.60%
发文量
163
审稿时长
4-8 weeks
期刊介绍: European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.
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