Defined daily doses (DDD) do not accurately reflect opioid doses used in contemporary chronic pain treatment

Nielsen, Suzanne, Gisev, Natasa, Bruno, Raimondo, Hall, Wayne, Cohen, Milton, Larance, Briony, Campbell, Gabrielle, Shanahan, Marian, Blyth, Fiona, Lintzeris, Nicholas, Pearson, Sallie, Mattick, Richard and Degenhardt, Louisa (2017) Defined daily doses (DDD) do not accurately reflect opioid doses used in contemporary chronic pain treatment. Pharmacoepidemiology and Drug Safety, 26 5: 587-591. doi:10.1002/pds.4168


Author Nielsen, Suzanne
Gisev, Natasa
Bruno, Raimondo
Hall, Wayne
Cohen, Milton
Larance, Briony
Campbell, Gabrielle
Shanahan, Marian
Blyth, Fiona
Lintzeris, Nicholas
Pearson, Sallie
Mattick, Richard
Degenhardt, Louisa
Title Defined daily doses (DDD) do not accurately reflect opioid doses used in contemporary chronic pain treatment
Journal name Pharmacoepidemiology and Drug Safety   Check publisher's open access policy
ISSN 1099-1557
1053-8569
Publication date 2017-05-01
Year available 2017
Sub-type Article (original research)
DOI 10.1002/pds.4168
Open Access Status Not yet assessed
Volume 26
Issue 5
Start page 587
End page 591
Total pages 5
Place of publication Chichester, West Sussex, United Kingdom
Publisher John Wiley & Sons
Language eng
Subject 2713 Epidemiology
2736 Pharmacology (medical)
Abstract Objective: To assess how well the defined daily dose (DDD) metric reflects opioid utilisation among chronic non-cancer pain patients. Design: Descriptive, cross-sectional study, utilising a 7-day medication diary. Setting: Community-based treatment settings, Australia. Subjects: A sample of 1101 people prescribed opioids for chronic non-cancer pain. Methods: Opioid dose data was collected via a self-completed 7-day medication diary capturing names, strengths and doses of each medication taken in the past week. Median daily dose was calculated for each opioid. Comparisons were made to the World Health Organization's (WHO) DDD metric. Results: WHO DDDs ranged from 0.6 to 7.1 times the median opioid doses used by the sample. For transdermal fentanyl and oral hydromorphone, the median dose was comparable with the DDD. The DDD for methadone was 0.6 times lower than the median doses used by this sample of chronic pain patients. In contrast, the DDD for oxycodone and transdermal buprenorphine, the most commonly used strong opioids for chronic pain in Australia, was two to seven times higher than actual doses used. Conclusions: For many opioids, there are key differences between the actual doses used in clinical practice and the WHO's DDDs. The interpretation of opioid utilisation studies using population-level DDDs may be limited, and a recalibration of the DDD for many opioids or the reporting of opioid utilisation in oral morphine equivalent doses is recommended. Copyright
Formatted abstract
Objective: To assess how well the defined daily dose (DDD) metric reflects opioid utilisation among chronic non-cancer pain patients.

Design: Descriptive, cross-sectional study, utilising a 7-day medication diary.

Setting: Community-based treatment settings, Australia.

Subjects: A sample of 1101 people prescribed opioids for chronic non-cancer pain.

Methods: Opioid dose data was collected via a self-completed 7-day medication diary capturing names, strengths and doses of each medication taken in the past week. Median daily dose was calculated for each opioid. Comparisons were made to the World Health Organization's (WHO) DDD metric.

Results: WHO DDDs ranged from 0.6 to 7.1 times the median opioid doses used by the sample. For transdermal fentanyl and oral hydromorphone, the median dose was comparable with the DDD. The DDD for methadone was 0.6 times lower than the median doses used by this sample of chronic pain patients. In contrast, the DDD for oxycodone and transdermal buprenorphine, the most commonly used strong opioids for chronic pain in Australia, was two to seven times higher than actual doses used.

Conclusions: For many opioids, there are key differences between the actual doses used in clinical practice and the WHO's DDDs. The interpretation of opioid utilisation studies using population-level DDDs may be limited, and a recalibration of the DDD for many opioids or the reporting of opioid utilisation in oral morphine equivalent doses is recommended.
Keyword Chronic pain
Defined daily dose (DDD)
Opioids
Oral morphine equivalent
Q-Index Code C1
Q-Index Status Provisional Code
Grant ID 1022522
1013803
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
Centre for Youth Substance Abuse Research Publications
 
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