Trends of prescription opioid use in Europe: A DARWIN EU® multinational cohort study including 7 European countries

Junqing Xie¹Mike Du¹Yuchen Guo¹Cesar Barboza²James T Brash³Antonella Delmestri¹Talita Duarte-Salles^2,4Jasmin Gratton³Romain Griffier⁵Raivo Kolde⁶Wai Yi Man¹Núria Mercadé-Besora⁷Marek Oja⁶Sarah Seager³Katia Verhamme²Dina Vojinovic⁸Edward Burn¹Daniel Prieto-Alhambra^1,2*Martí Català¹Annika M Jödicke¹

• ¹Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, England, United Kingdom
• ²Department of Medical Informatics, Erasmus Medical Center, Rotterdam, Netherlands
• ³IQVIA (United Kingdom), London, United Kingdom
• ⁴.Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAPJGol),, Barcelona, Catalonia, Spain
• ⁵Centre Hospitalier Universitaire de Bordeaux, Bordeaux, Aquitaine, France
• ⁶Institute of Computer Science, Faculty of Science and Technology, University of Tartu, Tartu, Tartu County, Estonia
• ⁷University Institute for Primary Care Research (IDIAP Jordi Gol), Barcelona, Catalonia, Spain
• ⁸IQVIA (Netherlands), Amsterdam, Netherlands

Background The opioid crisis has been a serious public health challenge in North America for decades, despite numerous efforts to mitigate its devastating consequences. As concerns about a potential similar situation evolving in Europe are rising, we evaluated the trends of opioid use and characterise indications in seven European countries. Methods We conducted a multinational cohort study using electronic health records from primary care (CRPD GOLD [UK], SIDIAP [Spain], IPCI [the Netherlands]), primary– and outpatient specialist care (IQVIA DA Germany, IQVIA LPD Belgium), hospital care (CHUBX [France]) and the Estonian Biobank (EBB), all mapped to the OMOP Common Data Model. All people registered in a contributing database for ≥365 days between 2012 and 2022 were included. Annual period prevalence and incidence rates of opioid prescriptions were estimated, and long-term trends were quantified through percent change between 2012 and 2019. New opioid users were characterised, including potential indications. Results The incidence of opioid prescriptions decreased in primary care between 2012 and 2019 by -50·7% (CPRD GOLD) and -2·0% (SIDIAP), while it increased in EBB (+52·8%) and CHUBX (+25·3%) data. Incidence of codeine and tramadol use decreased in most databases. However, prevalence of oxycodone, morphine, and fentanyl increased. Opioid use was highest in older age groups, and the majority of prescriptions were oral opioids. Respiratory conditions and pain-related conditions were the most common indications for new opioid users in outpatient settings. Conclusions Despite a decrease in new opioid prescriptions in many European countries, the prevalence of opioid use remained largely stable over the last decade. More data is needed to monitor the evolving opioid prescription patterns in the post-pandemic era in Europe.