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Defined daily doses (DDD) do not accurately reflect opioid doses used in contemporary chronic pain treatment

Journal Article


Abstract


  • Objective

    To assess how well the defined daily dose (DDD) metric reflects opioid utilisation among chronic non‐cancer pain patients.

    Design

    Descriptive, cross‐sectional study, utilising a 7‐day medication diary.

    Setting

    Community‐based treatment settings, Australia.

    Subjects

    A sample of 1101 people prescribed opioids for chronic non‐cancer pain.

    Methods

    Opioid dose data was collected via a self‐completed 7‐day medication diary capturing names, strengths and doses of each medication taken in the past week. Median daily dose was calculated for each opioid. Comparisons were made to the World Health Organization's (WHO) DDD metric.

    Results

    WHO DDDs ranged from 0.6 to 7.1 times the median opioid doses used by the sample. For transdermal fentanyl and oral hydromorphone, the median dose was comparable with the DDD. The DDD for methadone was 0.6 times lower than the median doses used by this sample of chronic pain patients. In contrast, the DDD for oxycodone and transdermal buprenorphine, the most commonly used strong opioids for chronic pain in Australia, was two to seven times higher than actual doses used.

    Conclusions

    For many opioids, there are key differences between the actual doses used in clinical practice and the WHO's DDDs. The interpretation of opioid utilisation studies using population‐level DDDs may be limited, and a recalibration of the DDD for many opioids or the reporting of opioid utilisation in oral morphine equivalent doses is recommended.

Authors


  •   Nielsen, Suzanne (external author)
  •   Gisev, Natasa (external author)
  •   Bruno, Raimondo (external author)
  •   Hall, Wayne (external author)
  •   Cohen, Milton (external author)
  •   Larance, Briony
  •   Campbell, Gabrielle (external author)
  •   Shanahan, Marian D. (external author)
  •   Blyth, Fiona (external author)
  •   Lintzeris, Nicholas (external author)
  •   Pearson, Sallie-Anne (external author)
  •   Mattick, Richard P. (external author)
  •   Degenhardt, Louisa (external author)

Publication Date


  • 2017

Citation


  • Nielsen, S., Gisev, N., Bruno, R., Hall, W., Cohen, M., Larance, B., Campbell, G., Shanahan, M., Blyth, F., Lintzeris, N., Pearson, S., Mattick, R. & Degenhardt, L. (2017). Defined daily doses (DDD) do not accurately reflect opioid doses used in contemporary chronic pain treatment. Pharmacoepidemiology and Drug Safety, 26 (5), 587-591.

Number Of Pages


  • 4

Start Page


  • 587

End Page


  • 591

Volume


  • 26

Issue


  • 5

Place Of Publication


  • United Kingdom

Abstract


  • Objective

    To assess how well the defined daily dose (DDD) metric reflects opioid utilisation among chronic non‐cancer pain patients.

    Design

    Descriptive, cross‐sectional study, utilising a 7‐day medication diary.

    Setting

    Community‐based treatment settings, Australia.

    Subjects

    A sample of 1101 people prescribed opioids for chronic non‐cancer pain.

    Methods

    Opioid dose data was collected via a self‐completed 7‐day medication diary capturing names, strengths and doses of each medication taken in the past week. Median daily dose was calculated for each opioid. Comparisons were made to the World Health Organization's (WHO) DDD metric.

    Results

    WHO DDDs ranged from 0.6 to 7.1 times the median opioid doses used by the sample. For transdermal fentanyl and oral hydromorphone, the median dose was comparable with the DDD. The DDD for methadone was 0.6 times lower than the median doses used by this sample of chronic pain patients. In contrast, the DDD for oxycodone and transdermal buprenorphine, the most commonly used strong opioids for chronic pain in Australia, was two to seven times higher than actual doses used.

    Conclusions

    For many opioids, there are key differences between the actual doses used in clinical practice and the WHO's DDDs. The interpretation of opioid utilisation studies using population‐level DDDs may be limited, and a recalibration of the DDD for many opioids or the reporting of opioid utilisation in oral morphine equivalent doses is recommended.

Authors


  •   Nielsen, Suzanne (external author)
  •   Gisev, Natasa (external author)
  •   Bruno, Raimondo (external author)
  •   Hall, Wayne (external author)
  •   Cohen, Milton (external author)
  •   Larance, Briony
  •   Campbell, Gabrielle (external author)
  •   Shanahan, Marian D. (external author)
  •   Blyth, Fiona (external author)
  •   Lintzeris, Nicholas (external author)
  •   Pearson, Sallie-Anne (external author)
  •   Mattick, Richard P. (external author)
  •   Degenhardt, Louisa (external author)

Publication Date


  • 2017

Citation


  • Nielsen, S., Gisev, N., Bruno, R., Hall, W., Cohen, M., Larance, B., Campbell, G., Shanahan, M., Blyth, F., Lintzeris, N., Pearson, S., Mattick, R. & Degenhardt, L. (2017). Defined daily doses (DDD) do not accurately reflect opioid doses used in contemporary chronic pain treatment. Pharmacoepidemiology and Drug Safety, 26 (5), 587-591.

Number Of Pages


  • 4

Start Page


  • 587

End Page


  • 591

Volume


  • 26

Issue


  • 5

Place Of Publication


  • United Kingdom