Accessibility of opioid analgesics and barriers to optimal chronic pain treatment in Poland in 2000–2015

• Published in: Supportive care in cancer 2017-03, Vol.25 (3), p.775-781
• Main Authors: Dzierzanowski, Tomasz, Cialkowska-Rysz, Aleksandra
• Format: Article
• Language: English
• Subjects: Analgesics, Opioid - administration & dosage; Analysis; Chronic pain; Chronic Pain - drug therapy; Chronic Pain - epidemiology; Consumption (Economics); Drug Prescriptions; Drug Utilization - statistics & numerical data; Health Services Accessibility - statistics & numerical data; Humans; Laws, regulations and rules; Medicine; Medicine & Public Health; Narcotics; Nursing; Nursing Research; Oncology; Opioids; Original; Original Article; Pain management; Pain Management - methods; Pain Management - statistics & numerical data; Pain Medicine; Poland - epidemiology; Rehabilitation Medicine; Topical analgesics; Transdermal drug delivery systems
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-016-3460-3

Purpose Based on the international reports, consumption of opioid analgesics in Poland is relatively low. There is limited information on possible impediments to optimal opioid use. This study was aimed to identify possible barriers to access to opioid analgesics and causes of failure to comply with current clinical guidelines. Methods Consumption data per capita in 2000–2015 were analyzed in terms of oral morphine equivalents in total, per prescription type, per reimbursement status, to identify the impact of regulations specific for Poland. Results The consumption of opioid analgesics has been consistently growing from 36.0 in 2000 to 103.4 mg oral morphine equivalents (OME) per capita in 2015, mainly thanks to strong opioid consumption growth. Tramadol is the most commonly used opioid in Poland. Fentanyl and buprenorphine transdermal formulations are the most frequently used strong opioid analgesics in terms of OME. The vast majority (92.8 %) of opioids were distributed upon for outpatient use in 2015, with a almost fourfold growth of consumption of strong opioids and almost threefold of weak opioids between 2000 and 2015. Strong opioids were 41 % of OME used upon prescription in 2015. Acceleration of consumption growth has been observed since 2013. Conclusions The prescription pattern does not abide by the current clinical guidelines for pain treatment, and the most often used opioids in Poland are tramadol, buprenorphine, and fentanyl. The use of opioids in Poland grows fast, with acceleration since 2013. The most important legal impediments of optimal opioid analgesics use have been lack of reimbursement, special prescription forms, and complicated prescribing rules.