Use of tramadol and other analgesics following media attention and risk minimization actions from regulators: a Danish nationwide drug utilization study

Abstract

Purpose: To describe the use of tramadol and other analgesics in Denmark focusing on the impact of media attention (June and December 2017) and regulatory actions (September 2017 and January 2018) on the use of tramadol.

Methods: Using nationwide registries, we identified all adults who filled a prescription for tramadol and other analgesics from 2014 to 2019. We described incidence rates, prevalence proportions, and total use of tramadol and other analgesics over time. We also described switching between analgesics, treatment duration, skewness in drug use, and doctor-shopping.

Results: From early 2017 until the end of 2019, total tramadol use decreased markedly while the use of morphine and oxycodone decreased slightly. The quarterly prevalence of tramadol use decreased from 32/1000 individuals in 2014 to 18/1000 at the end of 2019, dropping mainly at the time of media attention. Concomitantly, the quarterly prevalence increased for oxycodone (from 5.1 to 8.2) and morphine (from 8.5 to 9.8), mainly due to more short-term and sporadic users, and decreased for codeine (14 to 9.6). From 2014 to mid-2017, the incidence of tramadol use was stable (around 2.2/1000 person-months) but dropped in June 2017 to 1.7/1000, coinciding with the media attention. The incidence of tramadol use continued to decrease (to 1.1/1000 at the end of 2019).

Conclusion: We identified a decline in tramadol use coinciding with the media attention in 2017 and continuing during regulatory actions. There was generally no evidence of unintended effects on the utilization of opioids related to the media attention and regulatory actions.

Keywords: Drug utilization; Opioid use; Regulatory action; Tramadol.

Fig. 1

Total use of opioids measured in milligram OMEQ per 1000 individuals and specified by different opioids per month from 2014 to 2019. The three dashed vertical lines denote the time of the media attention (June 2017) and regulatory actions (September 2017 and January 2018) (see the main text for additional details)

Fig. 2

Prevalence proportion of opioid users per 1000 individuals per quarter from 2014 to mid-2019. Vertical lines represent media attention (June 2017), stricter reporting requirement (September 2017), and reclassification (January 2018) (see the main text for additional details)

Fig. 3

Monthly incidence rate of opioid users between 2014 and 2019. Vertical lines represent media attention (June 2017), stricter reporting requirement (September 2017), and reclassification (January 2018). Monthly incidence rates are calculated by dividing the monthly number of new users by the total number of adults in Denmark on the 1st day in each quarter

Fig. 4

Lorenz curve of tramadol use in 2019. The curve denotes the proportion X of the total filled amount of tramadol (measured in defined daily doses (DDDs)) in 2019 that is accounted for by the proportion X of users