Patient Characteristics and Changes in Long-Term Opioid Use Among Patients With Non-Cancer Pain in Dutch Primary Care 2013–2022: A Population-Based Cohort Study

Abstract

Background: Pain guidelines recommend de-prescribing long-term opioid treatment (LTOT) in non-cancer pain for reasons of risk–benefit balance. However, the prevalence and changes over time with regard to LTOT in patients with chronic non-cancer pain in Dutch primary care are unknown. Hence, we examined the prevalence and characteristics and investigated associated diagnoses, comorbidities, co-medications and changes in prescription numbers between 2013 and 2022. Methods: This retrospective population-based cohort study was conducted using the Rijnmond Primary Care Database, which includes over 500,000 patient records from at least 240 GPs within the greater region of Rotterdam. All episodes of LTOT (> 3 months) in patients > 18 years from 2013 to 2022 were included. Descriptive statistics were adopted to characterise the study cohort. The prevalence of LTOT from 2013 to 2022 was calculated per 100 patient years. Results: Musculoskeletal complaints were the main registered indication by the first prescription of opioids. Patients were more frequently female (66.9%), with a mean age of 62.6 years. Most common comorbidities included diabetes mellitus and depressive disorder. The prevalence of LTOT increased twofold from 0.54% (95% CI: 0.51–0.58) per 100 patient years in 2013 to 1.04% (95% CI: 1.00–1.07) in 2022. The proportion of LTOT episodes solely involving potent opioids slightly increased between 2013 and 2022. Conclusions: This study demonstrated a twofold increase in the prevalence of LTOT for chronic non-cancer pain in Dutch primary care from 2013 to 2022. Musculoskeletal pain complaints were the main indication. From 2013 to 2022 potent opioids assumed a more prominent role in LTOT. Significance Statement: The about twofold increase in long-term opioid therapy for chronic non-cancer pain between 2013 and 2022, along with the specific rise in potent opioid prescriptions in Dutch primary care, highlights an urgent need for future studies. These studies should focus on developing strategies to accelerate the implementation of revised primary care pain guidelines, especially given the limited effectiveness of long-term opioid treatment in non-cancer pain and the anticipated rise in chronic non-cancer pain due to Europe's ageing population.