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

Nielsen, S, Gisev, N, Bruno, R ORCID: 0000-0001-6673-833X, Hall, W, Cohen, M, Larance, B, Campbell, G, Shanahan, M, Blyth, F, Lintzeris, N, Pearson, S, Mattick, R and Degenhardt, L 2017 , 'Defined daily doses (DDD) do not accurately reflect opioid doses used in contemporary chronic pain treatment' , Pharmacoepidemiology and Drug Safety, vol. 26, no. 5 , pp. 587-591 , doi: 10.1002/pds.4168.

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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.

Item Type: Article
Authors/Creators:Nielsen, S and Gisev, N and Bruno, R and Hall, W and Cohen, M and Larance, B and Campbell, G and Shanahan, M and Blyth, F and Lintzeris, N and Pearson, S and Mattick, R and Degenhardt, L
Keywords: chronic pain, defined daily dose (DDD), opioids, oral morphine equivalent
Journal or Publication Title: Pharmacoepidemiology and Drug Safety
Publisher: John Wiley & Sons Ltd
ISSN: 1053-8569
DOI / ID Number: 10.1002/pds.4168
Copyright Information:

Copyright 2017 John Wiley & Sons, Ltd.

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