Use of tramadol and other analgesics following media attention and risk minimization actions from regulators: a Danish nationwide drug utilization study

Abstract

Purpose To describe the use of tramadol and other analgesics in Denmark focusing on the impact of media attention (June and December 2017) and regulatory actions (September 2017 and January 2018) on the use of tramadol. Methods Using nationwide registries, we identified all adults who filled a prescription for tramadol and other analgesics from 2014 to 2019. We described incidence rates, prevalence proportions, and total use of tramadol and other analgesics over time. We also described switching between analgesics, treatment duration, skewness in drug use, and doctor-shopping. Results From early 2017 until the end of 2019, total tramadol use decreased markedly while the use of morphine and oxycodone decreased slightly. The quarterly prevalence of tramadol use decreased from 32/1000 individuals in 2014 to 18/1000 at the end of 2019, dropping mainly at the time of media attention. Concomitantly, the quarterly prevalence increased for oxycodone (from 5.1 to 8.2) and morphine (from 8.5 to 9.8), mainly due to more short-term and sporadic users, and decreased for codeine (14 to 9.6). From 2014 to mid-2017, the incidence of tramadol use was stable (around 2.2/1000 person-months) but dropped in June 2017 to 1.7/1000, coinciding with the media attention. The incidence of tramadol use continued to decrease (to 1.1/1000 at the end of 2019). Conclusion We identified a decline in tramadol use coinciding with the media attention in 2017 and continuing during regulatory actions. There was generally no evidence of unintended effects on the utilization of opioids related to the media attention and regulatory actions.

Opioid use trends in Spain: the case of the island of La Gomera (2016–2019)

“…The use of tramadol has increased worldwide over the last decades. For example, in Denmark, its use doubled from 2011 to 2013 (Muller et al 2019 ), although a decline in prescription tramadol use was observed from 2014 to 2019 (Sorensen et al 2021 ). Mordecai et al ( 2018 ) mention several reasons for the increase in tramadol prescription and its consequences on public health in the UK.…”

Opioid Consumption Trends in Spain: The Case of the Island of La Gomera (2016-2019)

“…The use of tramadol has increased worldwide during the last decades. For example, in Denmark, it increased twice its use from 2011 to 2013, (Muller et al 2019), although a decline in tramadol use was observed from 2014 to 2019 (Sorensen et al 2021).…”

Prescription opioids among older adults: ten years of data across five countries

“…It is likely that this preference for weak opioids has been influenced by requirements for additional documentation when prescribing strong opioids, which are classified as narcotics. Products containing tramadol were, however, rescheduled as narcotic in Sweden in 2012 [ 23 ] and in Denmark in 2017 [ 24 ], leading to a rapid reduction in tramadol utilisation in both countries [ 24 ]. In Iceland, the high prevalence and low intensity of opioid utilisation indicates that small amounts of especially codeine are being dispensed to a relatively high proportion of the older population.…”

“…As for opioids, the Nordic market has previously been dominated by the use of codeine and tramadol, commonly described as weak opioids, that have required less stringent documentation compared to strong opioids [ 22 ]. However, to reduce the use of tramadol, it has recently been scheduled as a narcotic in both Sweden and Denmark [ 23 , 24 ]. Opioid utilisation has been described for the overall population in some Nordic countries, but recent descriptions lack a full picture of the utilisation in the five countries [ 22 , 25 – 27 ].…”