title: Differences in the consumption rates and regulatory barriers to the accessibility of strong opioid analgesics in Israel and St. Petersburg.
abstract: OBJECTIVE
  To compare trends in opioid consumption in Israel and St. Petersburg/Russia (morphine, oxycodone, pethidine, fentanyl, methadone, buprenorphine, trimeperidine, and papaveretum) over the period 2000-2008, and to describe the regulatory barriers to their accessibility as an exploratory variable for between-country differences.
  
  
  METHODS
  Data were drawn from the databases maintained by the Israel Ministry of Health's Pharmaceutical Administration and the St. Petersburg Central Pharmaceutical Reserve. The data were converted into a defined daily dose (DDD)/1,000 inhabitants/day. Regulation was evaluated according to the WHO guidelines for the assessment of national opioid regulation.
  
  
  RESULTS
  The opioid consumption rates in Israel were substantially higher than those in St. Petersburg. The excess in DDD/1,000 inhabitants/day was for fentanyl +0.287 in 2000 and +1.206 in 2008, for morphine +0.245 in 2000 and +0.122 in 2008, and for pethidine/trimeperidine +0.035 in 2000 and +0.007 in 2008. Oxycodone consumption increased in Israel from 0.31 DDD/1,000 inhabitants/day in 2000 to 0.46 DDD/1,000 inhabitants/day in 2008, whereas this analgesic is not available in St. Petersburg. Methadone and buprenorphine consumption rose in Israel, whereas these drugs are not available in Russia. Conversely, omnopon consumption decreased in St. Petersburg from 0.0206 DDD/1,000 inhabitants/day in 2000 to 0.00304 DDD/1,000 inhabitants/day in 2008, whereas the compound is not available in Israel. St. Petersburg differs from Israel with less opioid formulary availability and greater regulatory restrictions.
  
  
  CONCLUSIONS
  The results suggest that strong opioid analgesics consumption rates in St. Petersburg yield those in Israel, and that the between-countries differences in opioid formularies availability and legal and regulatory barriers to opioids accessibility are responsible for the consumption discrepancies.
authors.affiliation: Mental Health Services, Ministry of Health, 2 Ben Tabai Street, Jerusalem, 93591, Israel. alexander.ponizovsky@moh.health.gov.il
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Ponizovsky
authors.forename: Michael V
authors.initials: MV
authors.lastname: Pchelintsev
authors.forename: Eli
authors.initials: E
authors.lastname: Marom
authors.forename: Edwin E
authors.initials: EE
authors.lastname: Zvartau
mesh_terms: D000701:Analgesics, Opioid / Q000600:supply & distribution / Q000627:therapeutic use*; D016208:Databases, Factual; D011307:Drug Prescriptions; D004363:Drug Utilization / Q000639:trends; D004335:Drug and Narcotic Control; D005569:Formularies as Topic; D017408:Guidelines as Topic; D006297:Health Services Accessibility; D006801:Humans; D007557:Israel; D010593:Pharmaceutical Services / Q000331:legislation & jurisprudence*; D010818:Practice Patterns, Physicians'; D012426:Russia; D014504:Urban Health; D014944:World Health Organization
chemical_list: D000701:Analgesics, Opioid