Kristian Svendsen

Choosing the unit of measurement counts: the use of oral morphine equivalents in studies of opioid consumption is a useful addition to defined daily doses.

Aim: Defined daily dose (DDD) is the most common measurement unit used in drug consumption studies. The DDD for opioids may not reflect their relative clinical potencies. The aim of this study was to explore whether opioid consumption data may be interpreted differently when adding oral morphine equivalent (OMEQ) dose as a measurement unit compared with using DDD. Methods: The equianalgesic ratio of each opioid relative to morphine was tabulated. Data on opioid consumption expressed in DDD were converted to OMEQs using the equianalgesic ratios. The opioid consumption was compared in three different study settings: clinical data from an opioid switching study, trends within one country and a comparison between countries. Results: Using DDD, the opioid consumption in Norway between 2004–2008 increased of 6.7%, while the increase was 23.6% using OMEQ. While DDD/1000 inhabitants/day showed that Sweden had the highest consumption of opioids among the Nordic countries, OMEQ/1000 inhabitants/day showed that Denmark had the highest consumption. In the switching study DDD indicated a reduction in analgesic dosing and OMEQ an increase when switching from WHO step II to III. Conclusion: OMEQ reflects clinical dosing better than DDD, and can give additional insight into opioid consumption when combined with DDD. Using OMEQ can also lead to different conclusions in opioid consumption studies compared with using DDD alone.

Concomitant medication among persistent opioid users with chronic non-malignant pain

Recent guidelines for opioid treatment of chronic non‐malignant pain discourage co‐medication with benzodiazepines and benzodiazepine‐related hypnotics, whereas co‐medication with non‐opioid analgesics and co‐analgesics may offer a beneficial opioid sparing effect, and is recommended. The aim of this study was to describe 1‐year periodic prevalence of co‐medication with benzodiazepines, benzodiazepine‐related hypnotics, non‐opioid analgesics, co‐analgesics and antidepressants in persistent opioid users with chronic non‐malignant pain.

Differential patterns of opioid use : Defining persistent opioid use in a prescription database.

The aim of this study was to develop definitions to identify persons with clinically different patterns of persistent opioid use based on data from prescription databases.

Persistent opioid use and socio-economic factors: a population-based study in Norway.

A growing proportion of the population is using opioids for longer time periods, but little is known about the characteristics of patients who are persistent opioid users. We therefore studied the association between socio‐economic factors and persistent vs. short‐term opioid use 4 years later.

Reimbursement of analgesics for chronic pain

BACKGROUND The prevalence of chronic non-malignant pain in Norway is between 24% and 30%. The proportion of the population using opioids for non-malignant pain on a long-term basis is around 1%. The purpose of our study was to investigate how many were prescribed analgesics on reimbursable prescription under reimbursement code -71 (chronic non-malignant pain) in 2009 and 2010, which analgesics were prescribed and whether prescribing practices were in accordance with national guidelines. MATERIAL AND METHOD We retrieved pseudonymised data from the National Prescription Database on all those who received drugs with reimbursement code -71 in 2009 and 2010. The data contain information on drug, dosage, formulation, reimbursement code and date of issue. RESULTS 90,731 patients received reimbursement for drugs indicated for chronic non-malignant pain in 2010. Of these, 6,875 were given opioids, 33,242 received paracetamol, 25,865 non-steroid inflammatory drugs (NSAIDs), 20,654 amitryptiline and 16,507 gabapentin. Oxycodone was the most frequently prescribed opioid, followed by buprenorphine, tramadol and codeine/paracetamol. Of those who were prescribed opioids, 4,047 (59%) received mainly slow-release opioids, 2,631 (38%) also received benzodiazepines and 2,418 (35%) received benzodiazepine-like sleep medications. CONCLUSION The number of patients who received analgesics and opioids on reimbursable prescriptions was low compared to the proportion of the population with chronic pain and the proportion using opioids long-term. 38% of those reimbursed for opioids also used benzodiazepines, which is contrary to official Norwegian guidelines.

433 MONITORING THE OPIOID CONSUMPTION: MORPHINE-EQUIVALENT DEFINED DAILY DOSE AS A SUPPLEMENT TO DDD

Reference(s) [1] Esposito C, Borzi P, Valla JS et al. Laparoscopic versus open appendicectomy in children: a retrospective comparative study of 2,332 case. World J Surg. 2007; 31(4): 750–5. [2] Aziz O, Athanasiou T, Tekkis PP et al. Laparoscopic Versus Open Appendicectomy in Children A Meta-Analysis. Anals of Surgery 2006; 243(1): 17–27. [3] Vernon AH, Georgeson KE and Harmon CM. Pediatric laparoscopic appendectomy for acute appendicitis. Surg Endosc. 2004; 18(1): 75–9.

Adverse drug reaction reporting: how can drug consumption information add to analyses using spontaneous reports?

PurposeSpontaneous reporting of adverse drug reactions (ADRs) is a cornerstone in pharmacovigilance. However, information about the underlying consumption of drugs is rarely used when analysing spontaneous reports. The purpose of this study was to combine ADR reports with drug consumption data to demonstrate the additional information this gives in various scenarios, comparing different drugs, gender-stratified sub-populations and changes in reporting over time.MethodsWe combined all Norwegian ADR reports in 2004–2013 from the EudraVigilance database (n = 14.028) with dispensing data from the Norwegian Prescription Database (more than 800 million dispensed prescriptions during 2004–2013). This was done in order to calculate drug-specific consumption-adjusted adverse drug reaction reporting rates (CADRRs) by dividing the number of reports for each drug with the number of users of the drug during the same time period.ResultsAmong the ten drugs with the highest number of ADR reports and the ten drugs with the highest CADRR, only four drugs were in both categories. This indicates that drugs with a high number of reports often also have a high number of users and that CADRR captures drugs with potentially relevant safety issues but a smaller number of users. Comparing reported ADRs in females and males using methylphenidate, we found that the two groups report different ADRs. Finally, we showed that changes in ADR reporting for simvastatin and atorvastatin during 2004–2013 were due to changes in consumption and that atorvastatin had a higher CADRR but fewer reports than simvastatin.ConclusionsCADRR provides additional information compared with number of reports alone in studies using spontaneous reports. It is important for researchers to adjust for consumption whenever possible in pharmacovigilance studies.

A medication assessment tool (MAT) for use in identifying patients who are poorly controlled or well-controlled on oral anticoagulants

ESCP 7th spring conference on clinical pharmacy, tackling inequalities in the delivery of pharmaceutical care, 16–19 May 2007, Edinburgh, UK PC-40 An evaluation of pharmacist prescribing for patients with hypertension Mohammed Ommar Ahmed, Sandra O’Neill, Fiona Reid, Moira Kinnear Lothian Pharmacy Practice Unit, Department of Pharmacy, NHS Lothian, Edinburgh, United Kingdom Background and objective A pharmacist-led cardiovascular risk clinic is established in two general practices. The pharmacist has implemented supplementary prescribing into routine practice. This study evaluated the opinions and expectations of doctors and patients one year after pharmacist prescribing was established. Clinical outcomes associated with the clinic are reported elsewhere [1, 2]. Design A questionnaire was designed following semi-structured one to one audio taped interviews with three randomly selected patients. The questionnaire was piloted and posted to 201 patients. One to one structured interviews were audio taped with four doctors. Setting Two general medical practices. Main outcome measures Frequency and nature of questionnaire/ interview responses. Results The questionnaire response rate was 74% (148/201) with an equal proportion of responders from both practices with no gender differences. Hypertension management by the pharmacist was preferred by 91 (61%) patients, 6 (4%) preferred management by their doctor. The service was rated excellent or good by 133 (90%) patients, 132 patients (89%) fully understood the information provided about their medication. One hundred and fifteen patients (88%) were satisfied with the service they received from community pharmacy for minor ailments; however, only 32 patients (22%) agreed that they would be happy to have their hypertension managed in the community pharmacy. When suggested that a similar model to the practice clinic, might be available in community pharmacy, the proportion increased to 42%. Doctors recognised the benefits of the clinic to both patients and themselves. Independent pharmacist prescribing was considered to be a natural development of this service and would enable prescribing for other conditions. Although the benefits in terms of continuity of care were acknowledged, doctors have concerns regarding competence and communication necessary to deliver a similar service from the community pharmacy. Conclusions Patients and doctors are satisfied with the pharmacist’s supplementary prescribing clinic. They acknowledge that pharmacists have the skills and competence to provide these services which result in better patient care. Although the patients and GPs in this study were satisfied with the current service, they indicated less enthusiasm for new services with which they may lack confidence, an issue which must be addressed to support future development of supplementary prescribing.