Key opioid prescription concerns in cancer patients: A nationwide study.
Opioids are crucial in cancer pain management. We examined the nationwide prescription patterns of opioids in Taiwan cancer patients to find the potential concerns.



We reviewed the claims database of the National Health Insurance of Taiwan for patients diagnosed with cancer from 2003 to 2011. The use and cost of analgesics were analyzed. Opioids were classified into recommended strong opioids (morphine and transdermal fentanyl), recommended weak opioids (tramadol, buprenorphine, and codeine), and unrecommended opioids (propoxyphene, nalbuphine, and meperidine).



We enrolled 1,424,048 patients with cancer, and ∼50% of them took analgesics. Among analgesic users, patients who used opioids increased from 48.2% in 2003 to 52.0% in 2010. Approximately 92% of the opioid use came from recommended opioids, either strong (51%) or weak opioids (41%). The ratio of the use of short-acting strong opioids to that of long-acting opioids increased from 0.41 in 2003 to 0.63 in 2011. Transdermal fentanyl accounted for > 50% of the use of strong opioids. Among weak opioids, the use of tramadol gradually increased to 71% in 2011. On average, opioids contributed to 0.79‰ of all medical expenditures and 2.94‰ of all medication costs.



The use of short-acting strong opioids increased during the study period. Instead of oral opioids, transdermal fentanyl was the most commonly used opioid among Taiwan cancer patients. The use of weak opioids, particularly tramadol, was high. These concerns should be the focus of pain management education.
Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan; Department of Anesthesiology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacology, College of Medicine, National Taiwan University, Taipei, Taiwan.
Chih-Peng
CP
Lin
Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan.
Chih-Hung
CH
Hsu
Department of Pharmacology, College of Medicine, National Taiwan University, Taipei, Taiwan.
Wen-Mei
WM
Fu
Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.
Ho-Min
HM
Chen
Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.
Ying-Hui
YH
Lee
Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; National Taiwan University Cancer Center, Taipei, Taiwan.
Mei-Shu
MS
Lai
Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei, Taiwan; Taiwan Cancer Registry, P.O.Box 84-310, Taipei, Taiwan. Electronic address: yuyunshao@gmail.com.
Yu-Yun
YY
Shao
D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000191:economics / Q000627:therapeutic use*; D000072716:Cancer Pain / Q000188:drug therapy*; D011307:Drug Prescriptions; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D013624:Taiwan
D000701:Analgesics, Opioid
analgesics; cancer; costs; guidelines; opioids