AimsMonitoring opioid prescribing across different healthcare systems is essential to understanding population-level exposure and informing global health policies. This study examined opioid utilization in Scandinavian countries between 2010 and 2023 using multiple complementary metrics, addressing the limitations of single-metric comparisons.MethodsA repeated cross-sectional study utilizing publicly available drug use statistics on opioid analgesics (ATC group N02A) dispensed in pharmacies from Denmark, Norway and Sweden. We assessed annual changes in utilization based on four metrics: 1-year prevalence (users/1000 inhabitants/year), defined daily doses (DDD)/1000 inhabitants/day (TID), morphine milligram equivalents (MMEs)/TID, and MMEs/user/year.ResultsOpioid use declined in Denmark and Sweden-in both 1-year user prevalence and volumes of MMEs-while stabilizing in Norway. Norway consistently had a higher and stable prevalence of opioid users. Denmark led in total amounts of MMEs dispensed, likely due to more frequent morphine and oxycodone use, whereas Norway ranked highest in DDDs. Denmark and Sweden showed increasing preference for "strong opioids", while codeine-paracetamol and tramadol remained predominant in Norway. The prevalence of oxycodone users increased in Norway and Sweden, with Sweden having the highest prevalence of users but the lowest annual average volumes per user.ConclusionsThis study found major differences in total opioid use and substance-specific prescribing patterns, reflecting diverse pain management strategies across Scandinavia. Changing use patterns suggest evolving prescribing strategies and possible shifts in the target group for opioid pain therapy. In addition, metric-dependent variation underscores the need for using multiple complementary metrics to accurately interpret opioid utilization trends.

Purpose To analyse the reliability and validity of the Swedish indicator 'Drugs that should be avoided in older people'.Methods From a previous study that included consecutive primary care patients >= 65 years of age, all patients >= 75 years of age were analysed. Two physicians independently screened their medication lists and medical records, applying the Swedish indicator which includes potentially inappropriate medications (PIMs): long-acting benzodiazepines, drugs with anticholinergic action, tramadol, propiomazine, codeine, and glibenclamide. The clinical relevance of identified PIMs was independently assessed. Thereafter, the physicians determined in consensus whether some medical action related to the drug treatment was medically justified and prioritised before the next regular visit. If so, the drug treatment was considered inadequate, and if not, adequate.Results A total of 1,146 drugs were assessed in 149 patients (75-99 years, 62% female, 0-20 drugs per patient). In 29 (19%) patients, at least one physician identified >= 1 PIM according to the indicator at issue; 24 (16%) patients were concordantly identified with >= 1 such PIM (kappa: 0.89). Of 26 PIMs concordantly identified, the physicians concordantly assessed four as clinically relevant and 12 as not clinically relevant (kappa: 0.17). After the consensus discussion, six (4%) patients had >= 1 PIM according to the studied indicator that merited action. Using the area under the receiver operating characteristic (ROC) curve, the indicator did not outperform chance in identifying inadequate drug treatment: 0.56 (95% confidence interval: 0.46 to 0.66).Conclusion The Swedish indicator has strong reliability regarding PIM detection but does not validly reflect the adequacy of drug treatment.

A framework for analysing incidence in pharmacoepidemiology and drug statistics is suggested using statins as an example. A new case of statin use (first-ever use or recurrence of treatment) can be defined as new on the group (NoG), new on substance whether new on the group or not (NoS), new on substance and new on the group (NoS_and_NoG), new on substance and not new on the group (NoS_not_NoG). MethodIndividual-level dispensations of statins 2006-2019 for 1 017 058 individuals with at least one dispensation 2019 in Sweden. ResultsWith 12-month run-in, corresponding to at least 8 months without treatment, the incidence proportion of NoG was 13.39 new cases per 1000 inhabitants and 8.40 with 10-year run-in. Thus, 37% had first been treated with any statin between 12 months and 10 years before the index date.For atorvastatin, NoS was 10.69, NoS_and_NoG 9.99, and NoS_not_NoG 0.70 per 1000 inhabitants. 0.70 per 1000 inhabitants or 6.6% of new cases of atorvastatin represented a change from another statin during the run-in. ConclusionIt is essential to separate new cases that are new both on the substance and on the group from those that represent a change of therapy during the run-in.

i har tidigare rapporterat att förskrivningen av opioider i ATC-grupp N02A till personer 30 år och äldre i Sverige 2000–2015 minskat från 35,0 till 23,9 definierade dygnsdoser (DDD) per 1 000 invånare och dygn [1]. Mätt som morfinekvivalenter ökade förskrivningen med 22 procent under åren 2000–2006, för att sedan fram till 2015 vara i stort sett konstant. Årsprevalensen (som kan följas sedan år 2006) mätt i antalet individer med minst en expediering på apotek/1 000 invånare var 113,5 år 2006 och 111,5 år 2015.

Läkemedelsverket rapporterar att man inte, utifrån sitt etablerade arbetssätt, kan genomföra nytta–riskvärdering av läkemedel utanför godkänd indikation. 

Sjukvården har ett behov av en nationell process för värdering av off label-användning av vissa läkemedel. 

Sjukvården behöver också fler och innovativa akademiskt drivna läkemedelsstudier.

Purpose: For primary health care (PHC), hypertension is the number one diagnosis for planned health care visits. The treatment of high blood pressure (BP) and its consequences constitutes a substantial economic burden. In spite of efficient antihypertensive medications, a low percentage of patients reach a well-controlled BP. The PERson-centredness in Hypertension management using Information Technology (PERHIT) Study is a multicentre randomised controlled trial. PERHIT is designed to evaluate the effect of supporting self-management on systolic blood pressure by the use of information technology in Swedish primary health care. Materials and Methods: After inclusion, 900 patients from 36 PHC centres are randomised to two groups. In the intervention group, patients are provided with a self-management support system including a home-BP monitor and further requested to perform self-reports and measure BP every evening for eight consecutive weeks. In the control group, patients receive treatment as usual. Results: The primary outcome will be the change in systolic blood pressure in patients with hypertension. In addition, person-centredness, daily life activities, awareness of risk and health care costs will also be evaluated. Conclusion: The results of this randomised controlled trial with assessment of blood pressure and same-day self-reports will provide patients a tool to understand the interplay between blood pressure and lifestyle applicable to primary health care. The self-management support system may be of importance for improved adherence to treatment and persistence to treatment recommendations.

n/a

Opioid prescription changes in Sweden 2000-2015 In contrast to the well-established »opioid epidemic« in the US, very little is known about how the prescription of opioids in Sweden has developed during the last decade. Aggregated data from the open Statistical database of the Swedish Board of Health and Welfare were analyzed descriptively. The yearly prevalence of opioid prescription did not change 2006-2015, but there were dramatic shifts in the choice of opioids. During this period, dextropropoxyphene was pulled off the market. Tramadol was used by fewer individuals (-54 % over the decade), but dosages expressed as Defined Daily Dose/patient/year (DDD/pat/y) increased (+41 %). In contrast, oxycodone and morphine were used by more individuals (+465 % and +137 %, respectively), but DDD/pat/y decreased during the period (-56% and -54%). Studies on non-aggregated data from available registries are needed to further elucidate the circumstances and possible consequences of these shifts in opioid prescription patterns.

STUDY QUESTION Are Swedish women age 40–44 years with assumed early menopause ‘undertreated’ by hormone therapy (HT)?

SUMMARY ANSWER Many women with probable early menopause discontinue their HT after a short period of time. Thus, they fail to complete the recommended replacement up to age 51–52 years, the average age of menopause.

WHAT IS KNOWN ALREADY Spontaneous early menopause occurs in ∼5% of women age 40–45 years. Regardless of the cause, women who experience hormonal menopause due to bilateral oophorectomy before the median age of spontaneous menopause are at increased risk of cardiovascular disease, neurological disease, osteoporosis, psychiatric illness and even death.

STUDY DESIGN, SIZE, DURATION The study is descriptive, and epidemiological and was based on the use of national registers of dispensed drug prescriptions (HT) linking registers from the National Board of Health and Welfare and Statistics Sweden from 1 July 2005 until 31 December 2011.

PARTICIPANTS/MATERIALS, SETTING, METHODS The study population consisted of 310 404 women, 40–44 years old on 31 December 2005 who were followed from 1 July 2005 until 31 December 2011.

MAIN RESULTS AND THE ROLE OF CHANCE Only 0.9% of women 40–44 years old started HT during the study period. A majority of these women used HT <1 year.

LIMITATIONS, REASONS FOR CAUTION We do not know the indications that led to the prescription of HT but assume that early onset of menopause was the main reason. Because of the study design—making a retrospective study of registers—we can only speculate on the reasons for most of the women in this group discontinuing HT. Another limitation of this study is that we have a rather short observation time. However, we have up to now only been able to collect and combine the data since July 2005.

WIDER IMPLICATIONS OF THE FINDINGS As the occurrence of spontaneous early menopause in women age 40–45 is reported to be ∼5%, the fact that <1% of Swedish women age 40–44 are prescribed HT, and can be shown also to have had the medication dispensed at a pharmacy suggests an unexpectedly low treatment rate. Some women with early menopause may have used combined contraceptives as supplementation therapy, but in Sweden HT is the recommended treatment for early menopause so any such women are not following this recommendation. Women who experience early menopause are at increased risk for overall morbidity and mortality, and can expect to benefit from HT until they have reached at least the median age of spontaneous menopause. It is therefore important to individualize the information given these women and to convey new knowledge in this area to gynaecologists and physicians in general as well as the recommendation that women in this group continue HT at least until the average age for spontaneous menopause is reached.