Prescription of opioids in Italy: everything, but the morphine.

Prescription of opioids in Italy: everything, but the morphine Oral morphine remains the drug of choice for moderate or severe cancer pain and an important indicator of progress in cancer pain management, according to international guidelines and Cochrane systematic review [1–4]. The available data on the consumption of opioids, particularly of morphine, in Europe apparently show an inappropriate trend [5, 6]. We studied the trend in morphine and other strong opioids consumption in Italy from 2001 to 2008, by also including the two entries into the Italian market (oral oxycodone and buprenorphine TTS). Analysis of opioids consumption was carried out by using national data on the prescription of drugs charged to Italian National Health Service (NHS) in 2000–08. Data collection is handled by the national federation of private pharmacies operating within the NHS (Federfarma), which receives the figures from its provincial offices and processes them at a regional level and by the Comunal Pharmacies Association (Assofarm). The consumption of opioids in the first 9 months of the 2008 grew by 17%, in comparison with the same periods in 2007, confirming the positive trend over the last 8 years. The greatest increase in the use of opioid was for oxycodone (+94%) and, to a lesser extent, for buprenophine (8%) and fentanyl (5%). Only the consumption of morphine showed a 2% decrease. In the same period, morphine is the active compound with the minor prescription (10.8%), confirming the trend to decrease, initiated in 2005 (Figure 1). After being launched into the market in Italy at the end of the 2000, use of transdermal fentanyl has shown a considerable increase, by growing nearly nine times until September 2008 and representing 51% of the total opioids used (Figure 1). A trend to a progressive increase in consumption of buprenorphine has been recorded only after February 2005, concomitant with the exponential increase of the use of transdermal formulation, immediately after its launch into the market. In September 2006, consumption of buprenorphine exceeded consumption of morphine with 8.0 defined daily dose (DDD)/100 000 inhabitants per day and in the months later the gap between the two opioids prescription trends enlarged (Figure 1). Before that time transdermal buprenorphine constituted <10% of the total consumption of buprenorphine, but in April 2007 it has reached 95%. In 2008, buprenophine represented 14.2% of the total prescription of opioids (9.8 DDD/100 000 inhabitants per day). In 2005, consumption of oxycodone showed …