Objectives The aim of this participatory project is to raise awareness and promote adequacy among healthcare professionals in Catalonia (Spain) on opioid usage in patients with chronic non-cancer pain (CNCP).
This project led by the Essencial initiative, a public policy from the Catalan Agency for Health Quality and Assessment (AQuAS) from the Department of Health, elaborates evidence -based recommendations in order to reduce low-value practices (LVP) from the health system.
In Spain, opioid prescription has doubled in the last decade. In 2012, 10.618 defined daily dose/1.000 inhabitants/day (DHD) were dispensed, whereas in 2021 it increased up to 20.864 DHD. Opioid overuse has potentially fatal consequences due to overdose and respiratory depression, among others. It also increases opioid misuse risk all of what could be potentially prevented.
Method A task force with policy-makers and Scientific Societies was created to identify LVP regarding opioid overuse and prioritizing them considering their prevalence, associated risks and evidence robustness.
A multidisciplinary team was built to elaborate evidence-based recommendations, which summarized what the evidence said about these LVP and what associated risks could be prevented if the LVP wouldn’t happen. It had 14 members with different profiles: family doctors, anaesthesiologists, psychologists, physiotherapists, nurses and pharmacists. The amount and extent of low-value care was quantified and indicators for the follow-up were designed, all of this with real world data.
The recommendations were then critically appraised and received approval from the Catalan Scientific Societies related.
Dissemination through the web-site, social media (twitter, LinkedIn) and direct contact to Scientific Societies, policy-makers and the College of Physicians then occurred.
We are currently developing an infographic material adapted to citizenship about opioid overuse in CNCP.
Results Chronic pain is a common phenomenon in Catalonia, 30.2% of women and 19.2% of men report having it, and its prevalence increases when aging (2021). In Spain (2020), 7.6% reported suffering very mild pain, 12.9% mild pain, 13.2% moderate pain, 5.7% severe pain and 0.8% extreme pain. 5 recommendations on low-value care in CNCP were published. Topics on practices that should be prevented were: opioids as the only treatment, concomitant prescription of opioids and benzodiazepines, opioids dosing, opioids prescription length and concurrent treatment of opioids and gabapentinoids. Real world data analysis reveals that in Catalonia (2021), 310.951 people were taking strong opioids (4% of its population). Regarding inadequacy, 55% of people with CNCP who take strong opioids consume benzodiazepines, whereas 33% take opioids along with gabapentinoids. A retrospective longitudinal study reported that 87.4% patients with CNCP received doses >50 MME and 63.4% doses >90 MME.
Conclusions Opioid overuse is a public health concern that will continue to impact on the society and its care, as CNCP is becoming more prevalent and the elderly population is growing. Literature evidences that there are more effective and safer therapeutic strategies. Therefore, we need to deimplement these LVP on opioid overuse. The Essencial recently published an evidence-based guideline on how to deimplement directed to organisations and professionals, that could be of use. Reaching consensus throughout this participative process was also challenging. As we were about to publish some recommendations, the new CDC guideline was issued, so Catalan Scientific Societies hadn’t time to position themselves regarding new CDC statements. This led to some arrangements. In conclusion, there is a need as a public healthcare system to improve CNCP treatment and search for allies in the healthcare professional community in order to have high-value care and optimize opioid usage.
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