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      Trends in opioid utilization in Hungary, 2006–2020: A nationwide retrospective study with multiple metrics

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          Abstract

          Background

          Opioid use is well documented in several countries: some countries struggle with overuse, whereas others have almost no access to opioids. For Europe, limited data are available. This study analysed Hungarian opioid utilization in ambulatory care between 2006 and 2020.

          Methods

          We obtained national drug utilization data on reimbursed opioid analgesics (ATC code: N02A) from a national health insurance database for a 15‐year period. We investigated utilization trends, using three volume‐based metrics [defined daily dose per 1000 inhabitants per day (DID), oral morphine equivalent per 1000 inhabitants per day, packages dispensed per 1000 inhabitants per year]. We stratified data based on administration routes, analgesic potency and reimbursement categories.

          Results

          Total opioid utilization increased during the study period according to all three metrics (74% in DID) and reached 5.31 DID by 2020. Upward trends were driven by an increase both in weak and strong opioid use (79% vs. 53%). The most commonly used opioids were fentanyl (in the strong category; 0.76 DID in 2020) and tramadol (in the weak category; 2.62 DID in 2020). Overall, tramadol was also the most commonly used opioid throughout the study period. Oral administration of opioid medications was dominant. Based on reimbursement categories, musculoskeletal pain was becoming a more frequent indication for opioid use (1552% increase in DID), while opioid use for cancer pain declined significantly during the study period (−33% in DID).

          Conclusions

          Our low utilization numbers might indicate underuse of opioid analgesia, especially for cancer pain.

          Significance

          This study was one of the recent opioid utilization studies using three volume‐based metrics, covering a long time period. To our knowledge, this was also the first national, population level study describing opioid utilization in Hungary. National opioid utilization data suggested not an overuse but rather an underuse of opioid analgesics in a developed, Central European country.

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          Most cited references31

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          Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis.

          New drug treatments, clinical trials, and standards of quality for assessment of evidence justify an update of evidence-based recommendations for the pharmacological treatment of neuropathic pain. Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE), we revised the Special Interest Group on Neuropathic Pain (NeuPSIG) recommendations for the pharmacotherapy of neuropathic pain based on the results of a systematic review and meta-analysis.
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            CDC Guideline for Prescribing Opioids for Chronic Pain--United States, 2016.

            Primary care clinicians find managing chronic pain challenging. Evidence of long-term efficacy of opioids for chronic pain is limited. Opioid use is associated with serious risks, including opioid use disorder and overdose.
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              The individual and societal burden of chronic pain in Europe: the case for strategic prioritisation and action to improve knowledge and availability of appropriate care

              Background Chronic pain is common in Europe and elsewhere and its under treatment confers a substantial burden on individuals, employers, healthcare systems and society in general. Indeed, the personal and socioeconomic impact of chronic pain is as great as, or greater, than that of other established healthcare priorities. In light of review of recently published data confirming its clinical and socioeconomic impact, this paper argues that chronic pain should be ranked alongside other conditions of established priority in Europe. We outline strategies to help overcome barriers to effective pain care resulting in particular from deficiencies in education and access to interdisciplinary pain management services. We also address the confusion that exists between proper clinical and scientific uses of opioid medications and their potential for misuse and diversion, as reflected in international variations in the access to, and availability of, these agents. Discussion As the economic costs are driven in part by the costs of lost productivity, absenteeism and early retirement, pain management should aim to fully rehabilitate patients, rather than merely to relieve pain. Accredited education of physicians and allied health professionals regarding state-of-the-art pain management is crucial. Some progress has been made in this area, but further provision and incentivization is required. We support a tiered approach to pain management, whereby patients with pain uncontrolled by non-specialists are able to consult a physician with a pain competency or a specialist in pain medicine, who in turn can recruit the services of other professionals on a case-by-case basis. A fully integrated interdisciplinary pain service should ideally be available to patients with refractory pain. Governments and healthcare systems should ensure that their policies on controlled medications are balanced, safeguarding public health without undue restrictions that compromise patient care, and that physician education programmes support these aims. Summary Strategic prioritization and co-ordinated actions are required nationally and internationally to address the unacceptable and unnecessary burden of uncontrolled chronic pain that plagues European communities and economies. An appreciation of the ‘return on investment’ in pain management services will require policymakers to adopt a long-term, cross-budgetary approach.
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                Author and article information

                Contributors
                matuz.maria@szte.hu
                Journal
                Eur J Pain
                Eur J Pain
                10.1002/(ISSN)1532-2149
                EJP
                European Journal of Pain (London, England)
                John Wiley and Sons Inc. (Hoboken )
                1090-3801
                1532-2149
                12 August 2022
                October 2022
                : 26
                : 9 ( doiID: 10.1002/ejp.v26.9 )
                : 1896-1909
                Affiliations
                [ 1 ] Institute of Clinical Pharmacy, Faculty of Pharmacy University of Szeged Szeged Hungary
                [ 2 ] Central Pharmacy Department, Albert Szent‐Györgyi Health Center University of Szeged Szeged Hungary
                [ 3 ] Emergency Department, Albert Szent‐Györgyi Health Center University of Szeged Szeged Hungary
                [ 4 ] Department of Neurology, Albert Szent‐Györgyi Health Center University of Szeged Szeged Hungary
                [ 5 ] Department of Oncotherapy, Albert Szent‐Györgyi Health Center University of Szeged Szeged Hungary
                [ 6 ] Department of Anesthesiology and Intensive Care, Albert Szent‐Györgyi Health Center University of Szeged Szeged Hungary
                [ 7 ] Department of Rheumatology and Immunology, Albert Szent‐Györgyi Health Center University of Szeged Szeged Hungary
                [ 8 ] Institute for Translational Medicine, Medical School University of Pécs Pécs Hungary
                Author notes
                [*] [* ] Correspondence

                Mária Matuz, Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szikra u. 8, H‐6725, Szeged, Hungary.

                Email: matuz.maria@ 123456szte.hu

                Author information
                https://orcid.org/0000-0002-7877-2399
                Article
                EJP2011 EURJPAIN-D-22-00133
                10.1002/ejp.2011
                9541344
                35848717
                956bdbfd-c7b9-403f-8d34-0aef77d3c710
                © 2022 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation ‐ EFIC ®.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 01 July 2022
                : 11 March 2022
                : 16 July 2022
                Page count
                Figures: 0, Tables: 6, Pages: 14, Words: 5899
                Funding
                Funded by: National Research, Development and Innovation Fund , doi 10.13039/501100012550;
                Award ID: TKP2021‐EGA
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                October 2022
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.2.0 mode:remove_FC converted:07.10.2022

                Anesthesiology & Pain management
                Anesthesiology & Pain management

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