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. 2024 Mar 7;13(1):12.
doi: 10.1186/s13584-024-00598-9.

Use of prescription opioids in Israel and socio-economic correlations between 2010 and 2020

Limor Adler  1   2 , Bar Cohen  3   4 , Shirley Shapiro Ben Daviv  5   3 , Ori Liran  5   3 , Daniella Rahamim-Cohen  5 , Afif Nakhleh  6   7   8 , Arnon Shahar  5 , Joseph Azuri  5   3
Affiliations

Use of prescription opioids in Israel and socio-economic correlations between 2010 and 2020

Limor Adler et al. Isr J Health Policy Res. .

Abstract

Background: The use of opioids has increased dramatically over the past several years in Israel. The aim of this study was to explore the trends of opioid consumption in Israel over a decade (2010-2020) stratified by socioeconomic status (SES), residence in the periphery, and ethnic background.

Methods: This cross-sectional study included all adult Maccabi Healthcare Services (MHS) patients who filled at least one prescription for opioids during the past decade. In order to standardize dosages and compare different opioid medications, we used the Morphine Milligram Equivalent (MME) conversion factor. We performed The Mann-Kendall test with autocorrelation correction to assess each trend. We then checked the differences between the trends with the Mann-Whitney test (for periphery) and the Kruskal Wallis (for SES and ethnic background).

Results: Between the years 2010-2020, 261,270 MHS members met the study's inclusion criteria. The proportions of opioids consumption were 23.9/1000 patients in 2010 and 27.6/1000 patients in 2020, representing a 15% increase. The average daily consumption of opioids was 4.6 and 10.5 MME in 2010 and 2020, respectively, an increase of 227%. The daily MME during 2020 was higher for residents of the periphery compared to non-periphery residents (daily MME of 14.0 compared to 10.1, respectively). Average daily MME increased gradually during the study period for all levels of SES; the values were highest for the low SES group and the lowest for the high SES group (daily MME in 2020 for the lowest, middle, and high SES groups were 15.2 vs. 11.8 vs. 6.7 respectively).

Conclusions: This study highlights that the primary concern in the increase of opioid use is the increasing dosages. The increase in the number of patients using opioids is also significant but to a minor extent. These phenomena disproportionately impact vulnerable populations. Education programs should be offered to physicians regarding the possible harms of long-term use of opioids. These programs should emphasize the risk factors associated with the development of opioid use disorder (OUD) and the caution needed when increasing dosages or switching to higher-potency drugs. Pain clinics and centers for rehabilitation for patients with chronic pain or OUD should be available, not only in central areas but also in the periphery of the country. These clinics and centers should use a holistic approach and a multidisciplinary team that includes specialists in pain and addiction. They should be financially accessible for patients from low SES group and provide solutions in multiple languages.

Keywords: Arab population; Minorities; Opioid usage; Orthodox-Jews; Peripherial residency; Socioeconomic status.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Total number of MHS patients fulfilling at least one prescription of opioids by year
Fig. 2
Fig. 2
Average MME per patient
Fig. 3
Fig. 3
Average daily MME per patient by periphery/non-periphery district and year
Fig. 4
Fig. 4
Average daily MME per patient by SES level and year
Fig. 5
Fig. 5
Rate of patients using opioids per 1000 MHS members by population group and year
Fig. 6
Fig. 6
Average daily MME per patient by population group and year
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References

    1. Lembke A, Humphreys K, Newmark J. Weighing the risks and benefits of chronic opioid therapy. Am Fam Phys. 2016;93(12):982–990. - PubMed
    1. Martin BC, Fan MY, Edlund MJ, Devries A, Braden JB, Sullivan MD. Long-term chronic opioid therapy discontinuation rates from the TROUP study. J Gen Intern Med. 2011;26(12):1450–1457. doi: 10.1007/s11606-011-1771-0. - DOI - PMC - PubMed
    1. Hegmann KT, Weiss MS, Bowden K, Branco F, DuBrueler K, Els C, et al. ACOEM practice guidelines: opioids for treatment of acute, subacute, chronic, and postoperative pain. J Occup Environ Med. 2014;56(12):e143–e159. doi: 10.1097/JOM.0000000000000352. - DOI - PubMed
    1. Addressing Problematic Opioid Use in OECD Countries 2019. https://www.oecd.org/health/addressing-problematic-opioid-use-in-oecd-co.... Accessed 23 December, 2023.
    1. Dahlhamer JM, Connor EM, Bose J, Lucas JL, Zelaya CE. Prescription opioid use among adults with chronic pain: United States, 2019. Natl Health Stat Rep. 2021;162:1–9. - PubMed

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