title: Introduction of low dose transdermal buprenorphine -- did it influence use of potentially addictive drugs in chronic non-malignant pain patients?
abstract: The aim was to study the introduction of the new low dose transdermal buprenorphine (LD-TD-BUP) in Norway, particularly with regard to former use and co-medication with other potentially addictive drugs. The nationwide Norwegian Prescription Database contains information on all prescription drugs dispensed to individual non-institutionalised patients, and we may follow all individuals who received LD-TD-BUP (Norspan) after marketing on the Norwegian market on 15/11/05. We studied all prescriptions of opioids and other potentially addictive drugs to patients receiving at least two LD-TD-BUP prescriptions during 2004-2006. Poisson regressions were run with concomitant use of addictive drugs (yes, no) as the endpoint. Overall, 1884, non cancer individuals received at least two prescription of LD-TD-BUP. Of these 91.7% received prescriptions of other opioids and 58.6% of them had also been prescribed benzodiazepines/carisoprodol before the prescription of LD-TD-BUP. Of the LD-TD-BUP users who received more than one prescription, 60% co-medicated with at least one other potentially addictive drug, and 24% with at least two. In the multivariate analysis, the variables associated with a higher likelihood of using co-medicated drugs were: previous use of benzodiazepines/carisoprodol relative risk RR=16.7 (95% CI 10.4-26.9), previous use of opioids RR=4.0 (1.9-8.7) and younger age 20-40 years RR=1.9 (1.6-2.3). So far, it is questionable whether the introduction of LD-TD-BUP actually has stabilised opioids consumption or whether it has complicated and increased the consumption of potentially addictive drugs.
authors.affiliation: Department of Pharmacoepidemiology, Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway. svetlana.skurtveit@fhi.no
authors.forename: Svetlana
authors.initials: S
authors.lastname: Skurtveit
authors.forename: Kari
authors.initials: K
authors.lastname: Furu
authors.forename: Stein
authors.initials: S
authors.lastname: Kaasa
authors.forename: Petter C
authors.initials: PC
authors.lastname: Borchgrevink
mesh_terms: D000279:Administration, Cutaneous; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects*; D014151:Anti-Anxiety Agents / Q000008:administration & dosage / Q000009:adverse effects; D001569:Benzodiazepines / Q000008:administration & dosage / Q000009:adverse effects; D002047:Buprenorphine / Q000008:administration & dosage* / Q000009:adverse effects*; D002328:Carisoprodol / Q000008:administration & dosage / Q000009:adverse effects; D016208:Databases, Factual; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D004363:Drug Utilization; D017723:Drug Utilization Review / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009125:Muscle Relaxants, Central / Q000008:administration & dosage / Q000009:adverse effects; D009664:Norway / Q000453:epidemiology; D010148:Intractable Pain / Q000188:drug therapy*; D010818:Practice Patterns, Physicians'; D012042:Registries; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000517:prevention & control
chemical_list: D000701:Analgesics, Opioid; D014151:Anti-Anxiety Agents; D009125:Muscle Relaxants, Central; D001569:Benzodiazepines; D002328:Carisoprodol; D002047:Buprenorphine