Use of tramadol and other analgesics following media attention and risk minimization actions from regulators: a Danish n
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PHARMACOEPIDEMIOLOGY AND PRESCRIPTION
Use of tramadol and other analgesics following media attention and risk minimization actions from regulators: a Danish nationwide drug utilization study Anne Mette Skov Sørensen 1 & Lotte Rasmussen 2 & Martin Thomsen Ernst 2 & Stine Hasling Mogensen 3 & Mona Vestergaard Laursen 3 & Espen Jimenez-Solem 1,4,5 & Anton Pottegård 2 Received: 20 May 2020 / Accepted: 7 October 2020 # The Author(s) 2020
Abstract Purpose To describe the use of tramadol and other analgesics in Denmark focusing on the impact of media attention (June and December 2017) and regulatory actions (September 2017 and January 2018) on the use of tramadol. Methods Using nationwide registries, we identified all adults who filled a prescription for tramadol and other analgesics from 2014 to 2019. We described incidence rates, prevalence proportions, and total use of tramadol and other analgesics over time. We also described switching between analgesics, treatment duration, skewness in drug use, and doctor-shopping. Results From early 2017 until the end of 2019, total tramadol use decreased markedly while the use of morphine and oxycodone decreased slightly. The quarterly prevalence of tramadol use decreased from 32/1000 individuals in 2014 to 18/1000 at the end of 2019, dropping mainly at the time of media attention. Concomitantly, the quarterly prevalence increased for oxycodone (from 5.1 to 8.2) and morphine (from 8.5 to 9.8), mainly due to more short-term and sporadic users, and decreased for codeine (14 to 9.6). From 2014 to mid-2017, the incidence of tramadol use was stable (around 2.2/ 1000 person-months) but dropped in June 2017 to 1.7/1000, coinciding with the media attention. The incidence of tramadol use continued to decrease (to 1.1/1000 at the end of 2019). Conclusion We identified a decline in tramadol use coinciding with the media attention in 2017 and continuing during regulatory actions. There was generally no evidence of unintended effects on the utilization of opioids related to the media attention and regulatory actions. Keywords Tramadol . Drug utilization . Regulatory action . Opioid use Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00228-020-03016-6) contains supplementary material, which is available to authorized users. * Anton Pottegård [email protected] 1
Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
2
Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, JB Winsløwsvej 19, 2, DK-5000 Odense, Denmark
3
The Danish Medicines Agencys Data Analytics Centre, Copenhagen, Denmark
4
Copenhagen Phase IV unit (Phase4CPH), Department of Clinical Pharmacology and Center of Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
5
Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
Introduction The use of prescription opioids, including tramadol, has increased worldwide during the l
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