[Trend in opioids use for chronic pain treatment at Clalit Health Services (2000-2004)].
BACKGROUND
Opioids are considered a cornerstone in the treatment of cancer and non-cancer pain. The World Health Organization considers a country's morphine consumption to be an important indicator of the quality of pain control. There is little or no use of opioids in nearly half of the countries in the world.


OBJECTIVE
To assess the change in trends of opioids use for chronic pain treatment over a period of five years (2000-2004) among members of Clalit Health Services (CHS) in Israel.


METHODS
Data on the consumption of opioid analgesic drugs that were authorized for use in Israel during the years 2000-2004 were obtained from the computerized data bases of CHS. In addition, patient's demographic details and cancer morbidity were also extracted. To make the patient's use of opioids comparable, we analyzed the data by translating all opioids consumption (fentanyl patch, oxycodone, methadone, hydromorphone) to oral morphine equivalents.


RESULTS
An increase of 68% in total morphine consumption was found between the years 2000 and 2004 (from 56.4 Kg to 94.9 Kg) and in mg morphine per prescription from 15.7 to 25.3 mg. The total amount of morphine per prescription increased from 834.2 mg to 892.9 mg. The total number of patients who received an opioid prescription multiplied by 1.47 (from 18,551 to 27,302) while the growth in total number of CHS members was significantly smaller. No significant differences were found during the years in the characteristics of patients who received opioids; regarding gender (58% were woman) and age (about 80% were 65 years old and above). During the year 2004, a preliminary examination of opioids consumption, comparing cancer and non-cancer pain patients, showed that cancer pain patients used 2.74 times higher dosage than non-cancer pain patients (6110.8 vs. 2225.6 mg/patients/year).


CONCLUSIONS
During the 5 year period evaluated, there is a growing trend in use of opioids at CHS in Israel. This trend may be an indication of the improvement in treatment of chronic pain.
Freud
Tami
T
Division of Community Health, Department Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev. freudt@bgu.ac.il
Brill
Silviu
S
Sherf
Michael
M
Singer
Yoram
Y
Vardy
Daniel
D
Shvartzman
Pesach
P
D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002908:Chronic Disease; D003153:Community Health Services / Q000706:statistics & numerical data; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy; D012189:Retrospective Studies
D000701:Analgesics, Opioid; D009020:Morphine