(P-010) Slovenia versus the Netherlands: A Comparison of Opioid Prescription Strategies

Background: Opioid use is increasing in many countries. One of the many reasons for this increase might be guideline driven opioid prescribing.

Objectives: We set out to compare the prevalence of analgesic prescriptions in Slovenia and the Netherlands. These countries differ in the sense that Slovenia has strict rules regarding the prescription of opioids (except tramadol), whereas in the Netherlands physicians are more lenient in opioid prescribing.

Methods: We conducted a cohort study in which we analysed national pain medication prescription data of the Netherlands and Slovenia from 2013 to 2018. We calculated the annual prevalence of opioids and for each individual country and presented it as percentage with corresponding 95% confidence intervals (CI). Demographic differences in age and sex were adjusted for with direct standardization. We additionally conducted a time-trend analysis for which relative risks (RR) with corresponding 95% CI were calculated. The population of calendar year 2013 of each country was taken as a reference in this analysis.

Results: In Slovenia, the standardized prevalence of opioid use was higher at all times (6.45 [95%CI, 6.41-6.48] for opioids) compared with the Netherlands (5.97 [95%CI, 5.96-5.99] for opioids). Over time the standardized prevalence of opioid use decreased in Slovenia (RR 0.85 [95%CI, 0.84-0.85] when comparing 2018 with 2013). In contrast, over the same time frame the standardized prevalence of opioid use increased (RR, 1.20 [95%CI, 1.19-1.20]) in the Netherlands. Of the registered opioid medications, oxycodone was barely used in Slovenia—0.31% and 0.28% of the total population in 2013 and 2018, respectively—while the annual prevalence of oxycodone use in the Netherlands was 1.06% in 2013 and it more than doubled in 2018 compared with 2013.

Conclusions: National prescription guidelines can have a large influence on the prevalence of analgesic use. When more stringent rules in opioid prescribing are adopted, as in Slovenia, a decrease in opioid use can be observed. In contrast, in the Netherlands, where the threshold for an opioid prescription is lower, opioid use, mainly that of oxycodone, is increasing.