Dynamics of filled opioid prescriptions in Austria: a retrospective population-based study

Background:

Effective pain management is an integral part of modern healthcare, and opioids are commonly used to treat severe pain. However, long-term opioid use raises concerns about dependency. Understanding the key drivers of opioid prescribing is critical to addressing the root causes of opioid misuse and preventing overuse. In addition, there are concerns about differences in the frequency of opioid prescribing between hospital staff, general practitioners and specialists.

Methods:

This retrospective, observational study analysed health insurance data from Austria's compulsory health insurance providers from January 2016 to December 2021. Demographic information and hospital data including discharge diagnoses according to ICD-10-CM were extracted anonymously. The aim of the study was to describe the dynamics of opioid prescriptions in the Austrian healthcare system. A risk factor analysis for a filled opioid prescription including covariates such as sex, age and various comorbidities was performed. Furthermore, the percentage of opioid prescriptions filled by different prescribers and of opioid prescriptions filled for opioid dependence was analysed.

Results:

The number of individuals included in this study was 7,280,246 (2021) representing >97% of the adult population. The percentages of insured persons in Austria filling a prescription for any opioid intended for analgesia were 4.22%, 4.17%, 3.95%, 3.88%, 3.74% and 3.60% in 2016 to 2021; while for opioids intended for the treatment of opioid dependence, the percentages were 0.22%, 0.22%, 0.22%, 0.23%, 0.23% and 0.24% in 2016 to 2021. General practitioners prescribed 87.73%, hospital staff 2.32% and specialists 2.17% of filled opioid prescriptions. The top 3 prescribing specialities were internal medicine (1.57%), orthopaedic and trauma surgeons (0.93%) and neurologists (0.39%). Hydromorphone (38.04%), tramadol (31.57%), fentanyl (15.39%), buprenorphine (4.91%), oxycodone (4.36%) and morphine (3.42%) were the most frequently prescribed opioids for analgesia between 2016 and 2021. We identified the following risk factors (p < 0.01) associated with filling an opioid prescription: diagnosed pain disorder, gonarthrosis, coxarthrosis, substance use disorder, malignant neoplasm, and hypertension.

Conclusions:

The percentage of insured individuals in Austria, who filled a prescription for any opioid intended for analgesia, decreased gradually from 4.22% in 2016 to 3.60% in 2021. Meanwhile, the percentage of insured individuals filling a prescription for opioids intended for the treatment of opioid dependence remained relatively stable, ranging from 0.22% to 0.24% over the study period. General practitioners were the main prescribers of filled opioid prescriptions. Hydromorphone and tramadol accounted for nearly 70% of all filled opioid prescriptions. Orthopaedic conditions such as cox- and gonarthrosis, together with pain disorders, are the major drivers of opioid prescriptions in Austria.