Prescribing patterns of opioid analgesics in Slovenia between 2010 and 2019

Bolečina je eden najpogostejših razlogov za obisk zdravnika. Za lajšanje blage bolečine se uporabljajo neopioidni analgetiki. Srednje močno in močno bolečino zdravimo tako, da dodamo še oziroma preidemo na opioidne analgetike. Pogosto predpisovanje opioidnih analgetikov na recept poveča verjetnost zlorab teh zdravil. Zlorabe opioidov vodijo v velik javnozdravstveni problem, poznan tudi kot opioidna kriza, ki je v nekaterih delih sveta v velikem razmahu. V nalogi smo analizirali vzorce predpisovanja opioidnih analgetikov v obdobju med 2010 in 2019. Raziskavo smo izvajali s pomočjo programa SPSS Statistics na osnovi anonimizirane evidence Zavoda zdravstvenega zavarovanja Slovenije o zdravilih na recept. V analizi smo ugotovili, da se je letna poraba šibkih opioidnih analgetikov v obdobju med 2010 in 2019 v številu definiranih dnevih odmerkov približno ohranjala. Za močne opioide so v letu 2019 predpisali 12,4 % receptov več kot 2010, vendar se je poraba močnih opioidov v številu definiranih dnevih odmerkov v tem času zmanjšala za 14,6 %. Med vzorci predpisovanja posameznih zdravilnih učinkovin smo opazili precejšnje razlike. Opazili smo tudi, da se je v opazovanem obdobju zmanjšalo predpisovanje opioidnih analgetikov v farmacevtskih oblikah s podaljšanim sproščanjem. Opioidni analgetik je v 2019 prejel skoraj vsak šestnajsti državljan Slovenije. V opazovanem obdobju se je število prejemnikov zmanjšalo za 10,4 %. S starostjo se je število prejemnikov močno povečevalo. Med starostniki (stari 65 let ali več) je recept za opioidni analgetik prejel malo več kot vsak šesti državljan Slovenije. Tudi ob upoštevanju starostne sestave prebivalstva je bilo med prejemniki vsa leta nekoliko več žensk. Več kot 91 % prejemnikov je v posameznem letu prejelo samo šibke opioide. V opazovanem obdobju smo opazili povečanje števila prejemnikov, ki so v posameznem letu prejeli samo močne opioide. Število novih prejemnikov se je od 2011 do 2019 zmanjšalo za 15,3 %. Na 97 % prvih receptov novim prejemnikom so bili predpisani šibki opioidi. Novi prejemniki so najpogosteje prejeli kombinacijo tramadola s paracetamolom. Od močnih opioidov so novim prejemnikom najpogosteje predpisali fentanil, oksikodon in njegovo kombinacijo z naloksonom, v zadnjih letih pa tudi tapentadol. Skladno s pričakovanji so novi prejemniki na prve recepte običajno prejeli nižje jakosti opioidov.Pain is one of the most common reasons why patients visit the doctor. Non-opioid analgesics are used to relieve mild pain. Moderate and severe pain is treated by adding or switching to opioid analgesics. Frequent prescription for opioid analgesics increases the likelihood of misuse of these drugs. The misuse of opioids can lead to a major public health problem such as the opioid crisis, which is widespread in some parts of the world. In this thesis, we analysed prescribing patterns of opioid analgesics between 2010 and 2019. The analysis was conducted using SPSS Statistics based on health claims data on prescriptions drugs obtained from the Health Insurance Institution of Slovenia. In the analysis, we found that between 2010 and 2019 the annual consumption of weak opioid analgesics in the number of defined daily doses had remained roughly the same. In 2019, 12.4% more prescriptions were written for strong opioids than in 2010, but the consumption of strong opioids in the number of defined daily doses had decreased by 14.6% over this period of time. We observed significant differences between the prescribing patterns for individual active substances. We also noticed that prescribing of opioid analgesics in sustained-release dosage forms had decreased over the period. We found that in 2019, almost one in sixteen Slovenian citizens received a prescription for an opioid analgesic. The number of recipients who received an opioid analgesic had decreased by 10.4% over the observation period. The number of recipients who received a prescription for an opioid analgesic increased steeply with age. Among the elderly (aged 65+), just over one in six Slovenian citizens received a prescription for an opioid analgesic. There were slightly more women among the recipients even if considered for age-sex structure. More than 91% of recipients received only weak opioids. Over the observation period, we observed an increase in the number of recipients who in a given year received only strong opioids. The number of new recipients had decreased by 15.3% from 2011 to 2019. In total, 97% of the first prescriptions to new recipients were for weak opioids. New recipients were most often prescribed a combination of tramadol with paracetamol, while of the strong opioids, fentanyl, oxycodone, its combination with naloxone and, in recent years, tapentadol were the most commonly prescribed. As anticipated, we observed that new recipients tended to receive lower strengths of opioids on their first prescriptions