(P-013) Opioid Consumption from 2013 to 2016 in South Africa: Morphine, Pethidine, Oxycodone and Tramadol

Background: Globally, the use of opioids is increasing and referral is made to an opioid crisis. Yet, studies report that opioid use in Africa remains low. Not many studies have been conducted quantifying opioid consumption in South Africa using standardized World Health Organization methodology.

Objectives: To measure consumption of four commonly prescribed opioids in South Africa using the number of DDDs/1000 inhabitants/day.

Methods: Opioid consumption in South Africa was calculated using the IMS database. The database reports only on drug sales in the private healthcare sector of South Africa. Data for four opioid analgesics (morphine, pethidine, oxycodone and tramadol) were extracted for four years (2013 to 2016). The ATC/DDD methodology was used to measure drug consumption. Statistics South Africa population figures were used.

Results: Twenty-six tradename products (different dosage forms and strengths) were available for morphine. The DDD/1000 inhabitants/day for morphine remained relatively stable over the four years (0.197 in 2013 and 0.181 in 2016). Pethidine had the lowest consumption of the four opioids (0.055 DDDs/1000 inhabitants/day in 2013 and 0.053 DDDs/1000 inhabitants/day in 2016). There were 14 pethidine trade name products available. Twelve tradename products for oxycodone were analyzed, of which four of them were combination products with naloxone. The combination of oxycodone and naloxone was introduced only at the end of 2015. The number of DDDs/1000 inhabitants/day for oxycodone was 0.097 in 2013, and showed an increase to 0.261 in 2016. Previous studies have reported the increase in the prescribing and use of tramadol in South Africa, and the study confirmed this trend. Tramadol, overall, had the highest consumption figures. The number of DDDs/1000 inhabitants/day increased from 4.107 in 2013 to 4.481 in 2014, 4.789 in 2015 and 5.058 in 2016.

Conclusions: Trends in opioid consumption can provide useful information. The increase in tramadol consumption is also observed in several other countries, and is a potential cause for concern. Although regarded as a safer opioid, it is known for its addictive potential and it has become a drug of abuse in many countries.