Global consumption of prescription opioid analgesics between 2009-2019: a country-level observational study

Abstract

Background: Opioid analgesics play a key role in pain management but providing access while mitigating risk of misuse and dependence remains a challenge. Tracking global consumption of all opioids over time can help identify emerging patterns and drivers of use.

Methods: Prescription opioid analgesic consumption was estimated for 76 countries between 2009 and 2019 using IQVIA MIDAS data. We reported country-level consumption trends in morphine milligram equivalents (MMEs), assessed differences in consumption between high-income (HICs), upper-middle income (UMICs), and low- and lower-middle income countries (LMICs), and identified country-level socioeconomic drivers of consumption using fixed-effects panel regression models.

Findings: Global opioid consumption rate declined from 216·3 to 151·5 morphine milligram equivalents per 1,000 inhabitants per day (MID) between 2009 and 2019, with consumption declines in the US and Germany. Overall, consumption rates increased in HICs by a median 36·6 MID (IQR, -7·5 -124·5) with substantial heterogeneity between countries. Median consumption rates were lower in UMICs (23·6 MID) and LMICs (8·3 MID) compared to HICs (345·1 MID) and increased by median 10·4 and 3·7 MID from 2009-2019, respectively. Consumption rates were associated with income (coefficient 18·84, 95% confidence interval 3·8-33·9) and trade (13·59, 1·3-25·8) in UMICs, and physician density (1·95, 1·2-2·7) in LMICs. Tramadol consumption rate increased in the study period and accounted for a relatively large proportion of total opioid volume consumed across all country-income groups.

Interpretation: Substantial heterogeneity in global opioid consumption patterns reflect the challenges involved with providing adequate access to opioid treatment while avoiding potential misuse.

Figure 1

Global opioid consumption by country:2009-2019. (A) Change in the national opioid consumption rate between 2009 and 2019 in morphine milligram equivalents (MME) per 1,000 inhabitants per day. Colour scale is continuous with darker shades indicating negative values and lighter shades indicating positive values. Countries with no data shaded in grey. (B) Opioid consumption rate by country for 2019 in MMEs per 1,000 inhabitants per day. Colours represent the 2014 World Bank income classification of high, upper-middle, and low- and lower-middle income countries.

Figure 2

Median opioid consumption rate in morphine milligram equivalents per 1,000 inhabitants per day by country income classification from 2009 to 2019. Lines represent the annual median opioid consumption rate. Colours represent the 2014 World Bank income classification of high, upper-middle, and low- and lower-middle income countries.

Figure 3

Proportion of the individual opioids consumed out of total opioid consumption in morphine milligram equivalents (MME) by country income classification in 2009 and 2019. Panels represent the 2014 World Bank income classification of high, upper-middle, and low- and lower-middle income countries. Colours represent the opioid consumed and the bars indicate the percentage consumed out of total MME opioid consumption in 2009 and 2019. Opioids in OTHER category listed in Supplementary material, Appendix 1. The US was the only major consumer of hydrocodone.

Figure 4

Opioid consumption trends of the high-income countries with the top six highest consumption rates in 2019, expressed in morphine milligram equivalents per 1,000 inhabitants per day (MID). Hydrocodone trend not shown because the US was the only major consumer. (A) Oxycodone consumption rate trends:2009-2019. (B) Tramadol consumption rate trends:2009-2019. (C) Fentanyl consumption rate trend: 2009-2019. (D) Morphine consumption rate trend: 2009-2019. Line colours and patterns represent the six countries with the highest consumption rate for each opioid in 2019. The data points represent the annual consumption rate in MID for each opioid.