title: Defined daily doses (DDD) do not accurately reflect opioid doses used in contemporary chronic pain treatment.
abstract: OBJECTIVE
  To assess how well the defined daily dose (DDD) metric reflects opioid utilisation among chronic non-cancer pain patients.
  
  
  METHODS
  Descriptive, cross-sectional study, utilising a 7-day medication diary.
  
  
  METHODS
  Community-based treatment settings, Australia.
  
  
  METHODS
  A sample of 1101 people prescribed opioids for chronic non-cancer pain.
  
  
  METHODS
  Opioid dose data was collected via a self-completed 7-day medication diary capturing names, strengths and doses of each medication taken in the past week. Median daily dose was calculated for each opioid. Comparisons were made to the World Health Organization's (WHO) DDD metric.
  
  
  RESULTS
  WHO DDDs ranged from 0.6 to 7.1 times the median opioid doses used by the sample. For transdermal fentanyl and oral hydromorphone, the median dose was comparable with the DDD. The DDD for methadone was 0.6 times lower than the median doses used by this sample of chronic pain patients. In contrast, the DDD for oxycodone and transdermal buprenorphine, the most commonly used strong opioids for chronic pain in Australia, was two to seven times higher than actual doses used.
  
  
  CONCLUSIONS
  For many opioids, there are key differences between the actual doses used in clinical practice and the WHO's DDDs. The interpretation of opioid utilisation studies using population-level DDDs may be limited, and a recalibration of the DDD for many opioids or the reporting of opioid utilisation in oral morphine equivalent doses is recommended. Copyright © 2017 John Wiley & Sons, Ltd.
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.|Drug and Alcohol Services, South Eastern Sydney Local Health District, NSW, Australia.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Nielsen
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Natasa
authors.initials: N
authors.lastname: Gisev
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.|School of Medicine (Psychology), University of Tasmania, Hobart, Tas., Australia.
authors.forename: Raimondo
authors.initials: R
authors.lastname: Bruno
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.|Centre for Youth Substance Abuse Research, University of Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, Australia.
authors.forename: Wayne
authors.initials: W
authors.lastname: Hall
authors.affiliation: St Vincent's Clinical School, UNSW, Darlinghurst, NSW, Australia.
authors.forename: Milton
authors.initials: M
authors.lastname: Cohen
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Briony
authors.initials: B
authors.lastname: Larance
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Campbell
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Marian
authors.initials: M
authors.lastname: Shanahan
authors.affiliation: Concord Clinical School, University of Sydney, Sydney, NSW, Australia.
authors.forename: Fiona
authors.initials: F
authors.lastname: Blyth
authors.affiliation: Drug and Alcohol Services, South Eastern Sydney Local Health District, NSW, Australia.|Discipline of Addiction Medicine, University of Sydney, Sydney, NSW, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lintzeris
authors.affiliation: Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Sallie
authors.initials: S
authors.lastname: Pearson
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Mattick
authors.affiliation: School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia.|Murdoch Children's Research Institute, The Royal Children's Hospital, Flemington, VIC, Australia.|Department of Global Health, School of Public Health, University of Washington, Seattle, WA, USA.
authors.forename: Louisa
authors.initials: L
authors.lastname: Degenhardt
mesh_terms: D000279:Administration, Cutaneous; D000284:Administration, Oral; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D001315:Australia; D059350:Chronic Pain / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*
chemical_list: D000701:Analgesics, Opioid
keywords: chronic pain; defined daily dose (DDD); opioids; oral morphine equivalent