New opioid prescription claims and their clinical indications: results from health administrative data in Quebec, Canada, over 14 years

• Published in: BMJ open 2024-04, Vol.14 (4), p.e077664-e077664
• Main Authors: Attisso, Eugene, Guenette, Line, Dionne, Clermont E, Kröger, Edeltraut, Dialahy, Isaora, Tessier, Sebastien, Jean, Sonia
• Format: Article
• Language: English
• Subjects: Adult; Algorithms; Analgesics, Opioid - therapeutic use; Cancer Pain - drug therapy; Chronic illnesses; Chronic Pain; Codes; Drug overdose; Drug Prescriptions; Drug stores; EPIDEMIOLOGY; Fiscal years; Health surveillance; Hospitalization; Humans; Musculoskeletal Pain - drug therapy; Narcotics; Pain; Pharmaceuticals; Pharmacy; Practice Patterns, Physicians; Prescriptions; PREVENTIVE MEDICINE; Public health; Quebec - epidemiology; Respiratory diseases; Retrospective Studies; Routinely Collected Health Data; Sociodemographics
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2023-077664

ObjectivesDescribe new opioid prescription claims, their clinical indications and annual trends among opioid naïve adults covered by the Quebec’s public drug insurance plan (QPDIP) for the fiscal years 2006/2007–2019/2020.Design and settingA retrospective observational study was conducted using data collected between 2006/2007 and 2019/2020 within the Quebec Integrated Chronic Disease Surveillance System, a linkage administrative data.ParticipantsA cohort of opioid naïve adults and new opioid users was created for each study year (median number=2 263 380 and 168 183, respectively, over study period).InterventionNo.Main outcome measure and analysesA new opioid prescription was defined as the first opioid prescription claimed by an opioid naïve adult during a given fiscal year. The annual incidence proportion for each year was then calculated and standardised for age. A hierarchical algorithm was built to identify the most likely clinical indication for this prescription. Descriptive and trend analyses were performed.ResultsThere was a 1.7% decrease of age-standardised annual incidence proportion during the study period, from 7.5% in 2006/2007 to 5.8% in 2019/2020. The decrease was highest after 2016/2017, reaching 5.5% annual percentage change. Median daily dose and days’ supply decreased from 27 to 25 morphine milligram equivalent/day and from 5 to 4 days between 2006/2007 and 2019/2020, respectively. Between 2006/2007 and 2019/2020, these prescriptions’ most likely clinical indications increased for cancer pain from 34% to 48%, for surgical pain from 31% to 36% and for dental pain from 9% to 11%. Inversely, the musculoskeletal pain decreased from 13% to 2%. There was good consistency between the clinical indications identified by the algorithm and prescriber’s specialty or user’s characteristics.ConclusionsNew opioid prescription claims (incidence, dose and days’ supply) decreased slightly over the last 14 years among QPDIP enrollees, especially after 2016/2017. Non-surgical and non-cancer pain became less common as their clinical indication.