Opioid Prescription in Switzerland: Appropriate Comedication use in Cancer and Noncancer Pain

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