Physicians More Cautious About Prescribing Strong Painkillers

Date: Aug-01-2012Ten percent of Norwegians are prescribed opioids every year. However, until recently, there has been no data available on how many users are regularly prescribed these drugs.

Kristian Svendsen, a doctoral research fellow at the Norwegian University of Science and Technology (NTNU) in Trondheim, states:

"We now know we are talking about approximately one per cent of the overall Norwegian population, which is not a particularly worrisome figure. I think many physicians, pharmacists and others have overestimated the proportion of regular users."

Opioids are natural and synthetic narcotics that alleviate pain and suppress coughing, but which can cause strong side effects and lead to dependency. The most frequently used opioid in Norway is codeine, an ingredient of Paralgin Forte and Pinex Forte. Other commonly used opioids include narcotics, such as morphine, tramadol and oxycodone.

Dr. Petter Borchgrevink of St. Olavs Hospital's National Competence Centre for Complex Symptom Disorders, who leads the study of Norwegians' use of opioids, explains:

"In the USA, painkiller abuse is considered the second-most pervasive substance abuse problem, after cannabis. This is one of the reasons that many people are worried about widespread dependency on Paralgin forte and opioids in Norway."

Kristian Svendsen developed advanced methods for measuring the use of opioids in different population groups in his doctoral research, and discovered that in contrast to previous beliefs, Norwegian physicians are more conservative about prescribing these drugs.

Svendsen evaluated data obtained from the Norwegian Prescription Database from 2004 to 2008 by recording all dispensed prescriptions to private individuals in Norway (around 500,000) and subsequently matching each prescription to its patient to assess the number of prescriptions for each individual.

He found that most of the 500,000 Norwegians who took opioids received only one prescription per year and that many individuals were prescribed two or three opioids following a fracture or surgery. Around 100,000 individuals received more than three prescriptions, although only a small percentage of these could be defined as regular opioid users.

Svendsen said: "Applying strict definitions, we found that at the end of 2007 just 0.16 per cent of the Norwegian population were using opioids round the clock, while one per cent were using opioids at least half the days in a one-year period."

Svendsen's study suggests that regular opioid users tend to do so over an extended period of time. He noted that 3 years after the start of the study, 7 out of 10 users still received opioids. Regular opioid users take these drugs for an average of 14 years. However, Svendsen warns not to automatically categorize this use as problematic dependency, saying:

"These patients may be dependent on their medication, but there is nothing necessarily wrong with that. We know that roughly three out of 10 Norwegians report suffering from chronic pain. Some of these are dealing with intense pain - which may help to explain the long-term use of painkillers."

It is necessary to monitor all regular opioid users. Physicians should know about the risks of side effects and dependency, and continually assess that their patients receive the most appropriate treatment.

Svendsen says: "Paralgin Forte and Pinex Forte are not an optimal treatment. First, they are short acting, so that patients must often take new tablets. Second, not everyone receives the full effect of this treatment."

Research has shown that one in ten patients is unable to convert the active ingredient codeine to morphine, which means that the medicinal effect in these people translates to about the same as taking paracetamol (acetaminophen), yet with the added drawback of side effects.

Svendsen concludes: "Physicians have an ingrained skepticism about switching to medications stronger than Paralgin Forte or Pinex Forte. But for some patients, particularly those with intense chronic pain, it would be better to prescribe stronger, longer-acting medications such as morphine."

Written by Petra Rattue

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