1. 2019;22;537-548Opioid Prescription in Switzerland: Appropriate Comedication use in Cancer and Noncancer Pain
   Analysis
   Jakob M. Burgstaller, MD, PhD, Ulrike Held, PhD, Andri Signorell, MSc, Johann Steurer, MD, Maria M. Wertli, MD, PhD, and Eva Blozik, MD.

BACKGROUND: In Europe, limited information on the use of opioids is available.

OBJECTIVES: To assess how guideline recommendations to manage opioid-related adverse events were followed in cancer- and noncancer-related opioid use.

STUDY DESIGN: Analysis of health insurance data of one of the major health insurers in Switzerland.

SETTING: All opioid claims between 2006 and 2014.

METHODS: Opioid episodes were cancer-related when cancer treatments were used within ± 3 months of the first opioid claim. Recurrent strong episodes were defined as >/= 2 opioid claims with at least one strong opioid claim. Episode duration were acute (< 90 days), subacute, or chronic (>/= 120 days >/= 90 days + >/= 10 claims).

RESULTS: Out of 591,633 opioid episodes 76,968 (13%) were recurrent episodes: 94% were noncancer related (83% in recurrent episodes) and 6% cancer related (17% recurrent). Chronic opioid use was observed in 55% (noncancer) and 58% (cancer) recurrent episodes. Recommended laxatives were used in 50% noncancer and in 67% cancer episodes. Antiemetic drugs were used in 54% noncancer and in 83% cancer episodes. Not recommended coprescription of benzodiazepines was observed in 34% recurrent noncancer and 46% cancer episodes.

LIMITATIONS: No clinical information was available to assess the indication for opioid use.

CONCLUSIONS: In this study, opioids were primarily used outside the context of cancer-related treatment. In noncancer-related opioid use, we found a substantial higher proportion without recommended laxative and antiemetic medications. Coprescription of benzodiazepines may increase the risk for opioid overdose and was present in one-third of the noncancer episodes and in almost every second cancer episode.

KEY WORDS: Pain medications, opioids, nonopioids, benzodiazepines, health insurance claims data, cancer pain, noncancer pain, chronic opioid use, adverse events prevention, guideline recommendations