Strong opioids are the cornerstone of cancer pain management. We examined the use of strong opioids among Taiwan cancer patients.
By reviewing the claims database of National Health Insurance of Taiwan, we enrolled all patients who had cancer diagnosis (ICD-9: 140-208) from 2003 to 2011 with prescription of opioids in either inpatient or outpatient records. The prescription and costs of opioid analgesics were recorded. Opioids were classified to 3 groups (strong: morphine and fentanyl patches; weak: tramadol, buprenorphine, and codeine; others: propoxyphene, nalbuphine, and meperidine). We used WHO defined daily dose (DDD) to calculate the use of different opioids.
A total of 624,397 cancer patients who have used opioids were enrolled. The median age was 63 years, and 58% of them were male. Annually, 44.4% to 48.3% of patients had ever used strong opioids, which was stationary in the study period. Conversely, the percentage of patients who had ever used weak opioids increased from 52.1% in 2003 to 69.1% in 2011, and that of patients who had ever used other opioids decreased from 66.7% to 45.7%. Among strong opioid users, the percentage of patients who had ever used short-acting morphine increased (78.3% to 92.8%), and that of patients who had ever used fentanyl patches and long-acting morphine decreased (50.4% to 33.2% and 13.3% to 7.8%, respectively). Strong opioids contributed approximately 50% of the use of all opioids in cancer patients. Among the use of these strong opioids, that of the fentanyl patch was the highest but decreased from 60.0% in 2003 to 51.4% in 2011. The use of short-acting morphine increased from 29.4% to 38.5% among all strong opioids, but the use of long-acting morphine was stationary (∼10%). The average annual cost of all opioids in cancer patients was 11.1 million USD, and 7.7 million (69%) of them were spent on strong opioids. The average annual costs of fentanyl patch, long-acting morphine, and short-acting morphine were 6.2 million, 0.6 million, and 0.9 USD, respectively.
In Taiwan cancer patients, 50% of the opioids use came for strong opioids, and the fentanyl patch was the most commonly used strong opioids.
Clinical trial identification
All authors have declared no conflicts of interest.