Hoe zorgvuldig worden voorschriften voor opioïden opgesteld? Een analyse van 1.000 voorschriften uitgevoerd in Belgische openbare apotheken

Abstract

Are opioid prescriptions written with care? An analysis of 1,000 prescriptions carried out in Belgian community pharmacies Opioid medicines have a specific risk-benefit ratio, which makes it absolutely necessary to prescribe them in an appropriate and careful manner. In the context of an increasing use of opioids, some quantitative and legal aspects of these prescriptions were investigated. In the wider Antwerp area, 1,178 prescriptions were analysed originating from 14 pharmacies. The majority were written electronically (74%). The sample originates mainly from general practitioners (68%), who wrote relatively more paper prescriptions (33%) than specialists (11%). Only 3% of the prescriptions made on paper met all the legal requirements, such as fully writing out digits or explicitly mentioning the posology. Electronic prescriptions scored better in this respect: the posology was missing in 14% compared to 82% of the prescriptions made on paper. The average number of DDDs (defined daily dose) of opioids included on 1 prescription was 20. The median and mean MME (morphine milligram equivalent) calculated with the prescriptions containing posology were 40 and 87 MME per day respectively. Prescriptions containing fentanyl had the highest MME, followed by oxycodone. For prescriptions containing multiple opioids, the MME increased to reach an average of 432 MME per day in the presence of 3 opioids on 1 prescription. These results show that, in the interest of patient safety, there is, on average, much room for progress in careful opioid prescribing. Legally correct prescriptions are an important and relatively easy objective. In addition, the averages of the total quantity of prescribed opioids and the frequent combination of more than 2 opioids strongly contrast with the current guidelines.