– We see a significant increase in the use of oxycodone across the entire healthcare system, while the use of morphine is declining in primary healthcare and only increasing slightly in hospitals, explains lead author Eirik Haarr from the University of Stavanger and KORFOR.
Researchers have analyzed the trends in the use of morphine and oxycodone from 2010 to 2021. They also investigated whether changes in the use of these two substances in hospitals may be related to developments in primary healthcare.
– We find a moderate correlation between hospitals and primary healthcare. When the use of one opioid increases in hospitals, we often see a similar trend among general practitioners. However, it is not possible to determine with certainty whether the influence goes more from hospitals to general practitioners or vice versa, says Haarr.
Researchers have also looked closer at possible explanations. The increase cannot be attributed to increased activity in hospitals. Instead, changes in procurement contracts may play a role: During this period, the number of procurement agreements for morphine in hospitals drastically decreased, while the number of agreements for oxycodone increased.
The choice of opioid has clinical significance. Oxycodone played a central role in the development of the opioid epidemic in the U.S. and may be associated with a higher risk of dependence and overdose, according to recent studies. In Norway, the recommendation is to use morphine as the first choice.
– Our findings underscore the need to closely monitor these developments. We are now planning a follow-up study to investigate the risks associated with the use of different types of opioids among Norwegian patients, says Haarr.
Another important finding is that general practitioners are responsible for nearly 90% of opioid prescriptions in Norway.
– If we are to succeed in changing practices, we also need to examine how hospital practices influence general practitioners, says co-author Torgeir Gilje Lid.
Finally, the researchers point to the need for a better understanding of how the procurement system and drug availability affect actual prescribing patterns.
Read the study:
• European Journal of Pain (subscription)
Contact:
Eirik Haarr, eirik.haarr@uis.no