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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 2016 Jun 28
Outpatient therapeutic chronic opioid consumption in Italy. A one-year survey
Luca MICELI 1, Rym BEDNAROVA 2, Miriam DI CESARE 3, Elisabetta SANTORI 3, Marco SPIZZICHINO 3, Lidia DI MINCO 3, Renato BOTTI 3, Massimo CASCIELLO 3, Giorgio DELLA ROCCA 1 ✉
1 Department of Anestesia and Intensive Care, University of Udine, Udine, Italy; 2 Health Agency Number 2, Pain Medicine and Palliative Care, Gorizia, Italy; 3 Ministry of Health, Rome, Italy
BACKGROUND: In Italy since the 38/2010 law concerning Palliative Care and pain therapy has been promulgated, the consumption of opioids started increasing. However, despite the availability of a large amount of data regarding opioid prescription, a database including all patients on chronic opioid therapy does not yet exist.
METHODS: Retrospective analysis of analgesic opioid consumption was performed between January 2013 and December 2013 using the data of national refunded medications for outpatients, collected by Italian Ministry of Health. We considered patients on chronic opioid therapy those patients with at least three opioids prescriptions in three consecutive months and/or six opioid prescriptions in six even not consecutive months in the observation period. We considered cancer patients those with neoplasm exemption code in the scheduled prescription and/or patients with at least one ROOs prescription (rapid onset opioids, approved in Italy for Break Through cancer Pain–BTcP- only). We also calculated the patient’s morphine daily mean dose (MED) converting all prescribed opioids in equivalent of morphine using specific conversion tables.
RESULTS: This census revealed a total of 422.542 patients in chronic therapy with opioids, of those 369.961 with chronic non-cancer pain and 52.581 with chronic cancer pain. This represents about 4% of the estimated requirement in Italy for both groups based on previous surveys regarding the prevalence of chronic pain.
CONCLUSIONS: Relatively to MED, We found that in Italy chronic cancer pain patients receive doses similar to patients with cancer pain in other Literature reports, whereas patients with chronic non-cancer pain received lower dosages.