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A nationwide study on consumption of opioid analgesics in Iran from 2000 to 2018

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Abstract

Background

Opioid analgesics play a unique role in pain management. National opioid consumption studies could provide indirect evidence of pain management in a country. National, regional, and global opioid consumption have been studied in other countries so far; however, conducting a focused study to illuminate the consumption of opioid analgesics over the past decades in Iran seemed necessary.

Aim

The main objective of this study was to determine the consumption of opioid analgesics and explore the trend of their use during 19 years in Iran.

Method

Iran pharmaceutical wholesale data were used to extract the annual consumption figures of the opioid analgesics in group N02A of the World Health Organization (WHO) Anatomical Therapeutic Chemical classification and were available in Iran (morphine, fentanyl, pethidine, and oxycodone as strong opioids and, tramadol and pentazocine as weak opioids), from 2000 to 2018. Using Defined Daily Dose (DDD) by WHO and Oral Morphine Equivalent (OMEQ), the amount of annual consumption was determined in DDD/1000 inhabitants/Day (DID) and OMEQ (mg)/1000 inhabitants/Day (OID).

Results

Total opioid analgesic utilization based on DID and OID increased 31.12-fold (from 0.0196 to 0.61) and 21.06-fold (from 1.97 to 41.5 mg) over 19 years, respectively with a significant sharp increase from 2003 to 2006 (ß = 1.78 (DID), P value < 0.001). Medications that constituted 70% of annual opioid analgesics utilization were morphine in 2000, compared to tramadol in 2018. The annual weak and strong opioids share were 86.7% and 13.2% in 2018, respectively.

Conclusion

Despite considerable growth in the consumption of opioid analgesics in Iran over nearly two decades, the consumption amount remained low, which might signal sub-optimal pain management. On the other hand, misuse and abuse seem to be the main reason behind significant increases in the consumption of opioid analgesics with less controlled distribution.

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Funding

The Research Council of Tehran University of Medical Sciences supported this study (Grant Number: 97-03-156-40703).

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Authors and Affiliations

  1. Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran

    Arash Kalantar & Mahya Rezaei

  2. Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran

    Aarefeh Jafarzadeh Kohneloo

  3. Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, 4th floor, No 92, Karimkhan Zand Ave., Hafte Tir Sq., Tehran, Iran

    Maryam Taghizadeh-Ghehi

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  1. Arash Kalantar
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Correspondence to Maryam Taghizadeh-Ghehi.

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Kalantar, A., Rezaei, M., Jafarzadeh Kohneloo, A. et al. A nationwide study on consumption of opioid analgesics in Iran from 2000 to 2018. Int J Clin Pharm 45, 397–405 (2023). https://doi.org/10.1007/s11096-022-01518-0

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