RT journal article
T1 Correlation Between Opioid Drug Prescription and Opioid-Related Mortality in Spain as a Surveillance Tool: Ecological Study
A1 Salazar Couso, Alejandro
A1 Moreno Pulido, Soledad
A1 Prego-Meleiro, P.
A1 Henares-Montiel, J.
A1 Pulido, J.
A1 Donat, M.
A1 Sotres-Fernandez, G.
A1 Sordo, L.
A2 Estadística e Investigación Operativa
A2 Matemáticas
K1 opioid
K1 overdose
K1 drug overdose
K1 opioid-related deaths
K1 mortality
K1 tramadol
K1 fentanyl
K1 substance use
K1 substance misuse
K1 substance abuse
K1 ecological study
K1 death
AB Background: Opioid drug prescription (ODP) and opioid-related mortality (ORM) have increased in Spain. However, theirrelationship is complex, as ORM is registered without considering the type of opioid (legal or illegal).Objective: This ecological study aimed to examine the correlation between ODP and ORM in Spain and discuss their usefulnessas a surveillance tool.Methods: This was an ecological descriptive study using retrospective annual data (2000-2019) from the Spanish generalpopulation. Data were collected from people of all ages. Information on ODP was obtained from the Spanish Medicines Agencyin daily doses per 1000 inhabitants per day (DHD) for total ODP, total ODP excluding those with better safety protocols (codeineand tramadol), and each opioid drug separately. Rates of ORM (per 1,000,000 inhabitants) were calculated based on deathsregistered (International Classification of Diseases, 10th Revision codes) as opioid poisoning by the National Statistics Institute,derived from the drug data recorded by medical examiners in death certificates. Opioid-related deaths were considered to be thosethat indicated opioid consumption (accidental, infringed, or self-inflicted) as the main cause of death: death due to accidentalpoisoning (X40-X44), intentional self-inflicted poisoning (X60-X64), drug-induced aggression (X85), and poisoning ofundetermined intention (Y10-Y14). A descriptive analysis was carried out, and correlations between the annual rates of ORMand DHD of the prescribed opioid drugs globally, excluding medications of the least potential risk of overdose and lowest treatmenttier, were analyzed using Pearson linear correlation coefficient. Their temporal evolution was analyzed using cross-correlationswith 24 lags and the cross-correlation function. The analyses were carried out using Stata and StatGraphics Centurion 19.Results: The rate of ORM (2000-2019) ranged between 14 and 23 deaths per 1,000,000 inhabitants, with a minimum in 2006and an increasing trend starting in 2010. The ODP ranged between 1.51 to 19.94 DHD. The rates of ORM were directly correlatedwith the DHD of total ODP (r=0.597; P=.006), total ODP without codeine and tramadol (r=0.934; P<.001), and every prescribed opioid except buprenorphine (P=.47). In the time analysis, correlations between DHD and ORM were observed in the same year,although not statistically significant (all P≥.05).Conclusions: There is a correlation between greater availability of prescribed opioid drugs and an increase in opioid-relateddeaths. The correlation between ODP and ORM may be a useful tool in monitoring legal opiates and possible disturbances in theillegal market. The role of tramadol (an easily prescribed opioid) is important in this correlation, as is that of fentanyl (the strongestopioid). Measures stronger than recommendations need to be taken to reduce off-label prescribing. This study shows that notonly is opioid use directly related to the prescribing of opioid drugs above what is desirable but also an increase in deaths.
PB XSL·FOS
SN 2369-2960
YR 2023
FD 2023
LK http://hdl.handle.net/10498/31464
UL http://hdl.handle.net/10498/31464
LA eng
DS Repositorio Institucional de la Universidad de Cádiz
RD 07-nov-2026