Risk Prescriptions of Strong Opioids in the Treatment of Chronic Non-Cancer Pain by Primary Care Physicians in Catalonia: Opicat Padris Project
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design
2.2. Study Population
2.3. Variables Included
- Concomitant risk prescription: defined as the concomitant prescription of SO with any of the active ingredients included in the following pharmacological groups (central nervous system depressant drugs and concomitant drugs with adverse effects proven): antidepressants [15,16], gabapentinoids [13,17,18,19], benzodiazepines and Z-drugs [7,10,11,12]. For extraction they were identified by their Anatomical Therapeutic Chemical Classification (ACT) code.
- The prescription of any of these drugs during the 100 days after the date of prescription of the SO was considered a concomitant prescription (according to chronic pain definition as ≥3 months).
- Doses of pregabalin and gabapentin prescribed in patients with a concomitant prescription of SO (variable included due to dose-related mortality in gabapentinoids concomitancy [18,19]). The dose per unit (tablet, capsule) was obtained and the daily dose was calculated using the dosage interval recommended in the data sheet (gabapentin every 8 h, pregabalin every 12 h).
- Prescription of IRF without prescription of a baseline SO in the previous 100 days (unauthorized prescription [20]).
2.4. Ethical Aspects
2.5. Statistical Analysis
3. Results
3.1. Association between Strong Opioids (SO) and Benzodiazepines
3.2. Association between SO and Antidepressants
3.3. Association between SO and Gabapentinoids
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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No Concomitant Medication (n = 2337) (10.2%) | Concomitant Medication (n = 20,354) (89.7%) | p-Value | |
---|---|---|---|
n(%) | n(%) | ||
Sex | <0.001 | ||
Female | 1594 (9.1) | 15,915 (90.9) | |
Male | 743 (14.3) | 4439 (85.7) | |
Socioeconomic level (in Euros) | <0.001 | ||
Exempt | 107 (7.8) | 1261 (92.2) | |
<18,000 | 1910 (10.4) | 16,478 (89.6) | |
18,001–100,000 | 316 (10.9) | 2592 (89.1) | |
>100,000 | 4 (14.8) | 23 (85.2) | |
Age (in years) | <0.001 | ||
<50 | 129 (7.1) | 1683 (92.9) | |
50–64 | 287 (7.3) | 3661 (92.7) | |
65–74 | 340 (9.1) | 3388 (90.9) | |
75–84 | 660 (10.4) | 5697 (89.6) | |
85–94 | 750 (12.7) | 5143 (87.3) | |
≥ 95 | 171 (17.9) | 782 (82.1) | |
Health region | 0.317 | ||
Urban | 1490 (10.3) | 12,962 (89.7) | |
Semi-urban | 568 (10.2) | 4989 (89.8) | |
Rural | 279 (10.4) | 2400 (89.6) |
Benzodiazepines | No. Patients | % |
---|---|---|
Lorazepam | 8027 | 50.54 |
Diazepam | 5931 | 37.34 |
Lormetazepam | 4124 | 25.96 |
Alprazolam | 3502 | 22.05 |
Zolpidem | 1525 | 9.6 |
Clorazepate | 782 | 4.92 |
Bromazepam | 485 | 3.05 |
Ketazolam | 231 | 1.45 |
Midazolam | 227 | 1.43 |
Diazepam in combination with pyridoxine and/or sulpiride | 172 | 1.08 |
Antidepressants | n Patients | % |
---|---|---|
Sertraline | 3569 | 23.9 |
Citalopram | 3514 | 23.53 |
Duloxetine | 3480 | 23.31 |
Amitriptyline | 3060 | 20.49 |
Mirtazapine | 2678 | 17.93 |
Paroxetine | 1845 | 12.36 |
Fluoxetine | 1340 | 8.97 |
Escitalopram | 1056 | 7.07 |
Venlafaxine/Desvenlafaxine | 456 | 3.05 |
Bupropion | 294 | 1.97 |
Clomipramine | 228 | 1.53 |
Mianserin | 169 | 1.13 |
Gabapentinoids | No. Patients | % |
---|---|---|
Gabapentin | 5573 | 49.46 |
Pregabalin | 7564 | 67.13 |
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Perelló-Bratescu, A.; Dürsteler, C.; Álvarez-Carrera, M.A.; Granés, L.; Kostov, B.; Sisó-Almirall, A. Risk Prescriptions of Strong Opioids in the Treatment of Chronic Non-Cancer Pain by Primary Care Physicians in Catalonia: Opicat Padris Project. Int. J. Environ. Res. Public Health 2022, 19, 1652. https://doi.org/10.3390/ijerph19031652
Perelló-Bratescu A, Dürsteler C, Álvarez-Carrera MA, Granés L, Kostov B, Sisó-Almirall A. Risk Prescriptions of Strong Opioids in the Treatment of Chronic Non-Cancer Pain by Primary Care Physicians in Catalonia: Opicat Padris Project. International Journal of Environmental Research and Public Health. 2022; 19(3):1652. https://doi.org/10.3390/ijerph19031652
Chicago/Turabian StylePerelló-Bratescu, Aina, Christian Dürsteler, Maria Asunción Álvarez-Carrera, Laura Granés, Belchin Kostov, and Antoni Sisó-Almirall. 2022. "Risk Prescriptions of Strong Opioids in the Treatment of Chronic Non-Cancer Pain by Primary Care Physicians in Catalonia: Opicat Padris Project" International Journal of Environmental Research and Public Health 19, no. 3: 1652. https://doi.org/10.3390/ijerph19031652