Patterns of initial opioid prescription and its association with short- and long-term use among opioid-naïve patients in Malaysia: a retrospective cohort study

• Main Authors: Zin, Che Suraya, Nazar, Nor Ilyani, Abdul Rahman, Norny Syafinaz, Ahmad, Wan Rohaidah, Rani,, Nurul Sahida, Ng, Kim Swan
• Format: Article
• Language: English; English; English
• Published: BMJ Publishing Group Ltd 2019
• Subjects: RM147 Administration of Drugs and Other Therapeutic Agents
• Online Access: http://irep.iium.edu.my/73146/1/Zin_Patterns%20of%20initial%20prescribingBMJ%20Open_e027203.full.pdf; http://irep.iium.edu.my/73146/7/73146_Patterns%20of%20initial%20opioid%20prescription%20and%20its%20association%20with%20short-term%20and%20long-term%20use%20among%20opioid-naive%20patients%20in%20Malaysia-%20a%20retrospective%20cohort%20study_Scopus.pdf; http://irep.iium.edu.my/73146/12/73146_Patterns%20of%20initial%20opioid%20prescription%20and%20its%20association%20_wos.pdf; http://irep.iium.edu.my/73146/; https://bmjopen.bmj.com/content/bmjopen/9/7/e027203.full.pdf

This study examined opioid prescription initiation patterns and their association with short- and long-term opioid use among opioid-naïve patients. Design This study was designed as a retrospective cohort study. Setting and participants In this study, we analysed the prescription databases of tertiary hospitals in Malaysia. This study included patients aged ≥18 years with at least one opioid prescription (buprenorphine, morphine, oxycodone, fentanyl, dihydrocodeine, or tramadol) between 1 January 2011 and 31 December 2016. These patients had no opioid prescriptions in the 365 days prior, and were followed-up for 365 days after the initial opioid prescription. Main outcome measures The main outcome measures were the number of short-term (<90 days) and long-term opioid users (≥90 days), initial opioid prescription period, and daily dose. Results There were 33752 opioid-naïve patients who received opioid prescriptions (n = 43432 prescriptions) during the study period. Of these, 29824 (88.36%) were short-term opioid users and 3928 (11.64%) were long-term opioid users. The majority of these short- (99.09%) and long-term users (96.18%) received an initial daily opioid dose of <50 mg/day with a short-acting opioid formulation. Short-term opioid users were predominantly prescribed opioids for 3-7 days (59.06%) by the emergency department (ED, 60.56%), while long-term opioid users were primarily prescribed opioids for ≥7 days (91.85%) by non-ED hospital departments (91.8%). The adjusted model showed that the following were associated with long-term opioid use: increasing opioid daily doses, prescription period ≥7 days, and long-acting opioids initiated by non-EDs. Conclusions The majority of opioid-naïve patients in tertiary hospital settings in Malaysia were prescribed opioids for short-term use. The progression to long-term use among opioid-naïve patients was attributed to the prescription of higher opioid doses for a longer duration as well as long-acting opioids initiated by non-ED hospital departments.