Opioid prescriber responsibility: A Danish drug utilization study

Br J Clin Pharmacol. 2023 Apr;89(4):1425-1430. doi: 10.1111/bcp.15595. Epub 2022 Nov 29.

Abstract

Aims: We describe the distribution of prescribers responsible for opioid initiation and maintenance (general practice, hospital prescribers and other prescribers) in Denmark.

Methods: We leveraged data on opioid fills from a 20% sample of all Danes alive during 2000-2021.

Results: Overall, general practitioners were responsible for most treatment initiation (74% during 2000-2021) and maintenance treatment (92%). However, while hospital prescribers initiated ≈20% of treatments during 2001-2012, this increased to 35% in 2021. Similarly, hospital prescriber's share of maintenance treatment increased from 5.9% during 2000-2012 to 13% in 2021. This change was particularly pronounced for morphine initiation (48% hospital prescribers in 2021 up from 38% during 2000-2010) and oxycodone initiation (78% up from 41%). Regarding choice of opioids, codeine use dropped markedly, in particular among hospital prescribers. Tramadol was consistently the most common first choice opioid in general practice (33% in 2021), whereas its use among hospital prescribers decreased (54% during 2000-2015 to 15% in 2021). Conversely, the proportion of treatment initiation by hospital prescribers composed of morphine and oxycodone increased to 38% and 42% in 2021, respectively.

Conclusions: General practice prescribes most opioids; however, hospital prescribers are increasingly responsible for opioid prescribing, in particular initiation of morphine and oxycodone.

Keywords: drug utilization; morphine and oxycodone; opioids; pain; pharmacotherapy; prescribing; tramadol.

MeSH terms

  • Analgesics, Opioid* / therapeutic use
  • Drug Prescriptions
  • Drug Utilization
  • Humans
  • Morphine
  • Oxycodone* / therapeutic use
  • Practice Patterns, Physicians'

Substances

  • Analgesics, Opioid
  • Oxycodone
  • Morphine