Opioid Prescription Patterns and Risk Factors Associated With Opioid Use in the Netherlands

Source: Bedene A, Lijfering WM, Niesters M, et al. Opioid Prescription Patterns and Risk Factors Associated With Opioid Use in the Netherlands. JAMA Netw Open. Published online August 28, 20192(8):e1910223. doi:10.1001/jamanetworkopen.2019.10223

KEY POINTS

Question  Are the prevalence of opioid prescriptions and the incidence of hospital admissions for opioid overdose and opioid overdose mortality changing in the Netherlands through time?

Findings  In this cohort study with nationwide data from the Netherlands, 814 211 individuals (4.9% of the total population) were prescribed an opioid in 2013, and 1 027 019 individuals (6.0% of the total population) were prescribed an opioid in 2017. Hospital admissions for opioid overdose increased from 9.2 per 100 000 inhabitants in 2013 to 13.1 per 100 000 inhabitants in 2017, and opioid overdose mortality increased from 0.8 per 100 000 inhabitants in 2013 to 1.2 per 100 000 inhabitants in 2017.

Meaning  Opioid prescription and associated adverse events are increasing in the Netherlands.

Abstract

Importance  An increase in opioid prescription has been observed in the Netherlands. It is vital to understand this increase and to identify risk factors for opioid prescription to ensure that health interventions remain appropriately targeted.

Objectives  To determine the prevalence of opioid prescriptions and adverse events associated with opioids, and to identify risk factors associated with opioid prescription in the Dutch population.

Design, Setting, and Participants  This cohort study used national statistics from the Netherlands from January 1, 2013, to December 31, 2017, including the full Dutch population of 16 779 575 people in 2013 and 17 081 507 people in 2017. Data from the Dutch Health Monitor surveys of 2012 and 2016 were also included. Databases were anonymized prior to analysis. All analyses were performed between December 2018 and February 2019.

Exposure  Opioid prescription.

Main Outcomes and Measures  The main outcomes were the dynamics of opioid prescriptions, hospital admissions for opioid overdose, and opioid overdose mortalities. The secondary outcome was risk factors associated with opioid prescription.

Results  In 2013, 814 211 individuals (4.9% of the total population) received an opioid prescription. In 2017, 1 027 019 individuals (6.0% of the total population) received at least 1 opioid prescription (mean [SD] age, 59.3 [18.5] years; 613 203 [59.7%] women). The rate of hospital admissions for opioid overdose was 9.2 per 100 000 inhabitants in 2013 and 13.1 per 100 000 inhabitants in 2017 (relative risk, 1.43 [95% CI, 1.34-1.52]). Similarly, an increased risk of opioid overdose death was observed, from 0.83 per 100 000 inhabitants in 2013 to 1.2 per 100 000 inhabitants in 2017 (relative risk, 1.49 [95% CI, 1.20-1.85]). Based on data from the 2012 Dutch Health Monitor survey, risk factors associated with opioid prescription included being older than 65 years (odds ratio [OR], 4.20 [95% CI, 3.98-4.43]), having only a primary school education (OR, 3.62 [95% CI, 3.46-3.77]), being widowed (OR, 3.30 [95% CI, 3.13-3.49]), reporting always feeling symptoms of depression (OR, 3.77 [95% CI, 3.41-4.18]), and reporting poor or very poor physical health (OR, 10.40 [95% CI, 10.01-10.81]). Self-reported back pain (OR, 4.34 [95% CI, 4.23-4.46]) and rheumatoid arthritis or fibromyalgia (OR, 3.77 [95% CI, 3.65-3.90]) were also associated with opioid prescription. However, unemployment (OR, 1.05 [95% CI, 0.96-1.13]) was not associated with opioid prescription, and alcohol use disorder (OR, 0.76 [95% CI, 0.73-0.80]) was negatively associated with opioid prescription.

Conclusions and Relevance  This study found that opioid prescriptions have increased in the Netherlands. Although the risk of adverse events is still relatively low, there is an urgent need to review pain management to prevent a further increase in opioid prescription.