Opiate Analgesics Over-Use in Bulawayo: A Root Causes Follow-Up Pharmacovigilance Study 2020–2021

Abstract

Observed trends in the over usage of opioid analgesics by both patients and prescribers locally have significantly increased and this may result in tolerance, dependence and addiction among other undesirable effects. Demand for and consumption of opiate analgesics has risen by over three-fold in the past five years in Bulawayo city, according to local surveys. The present pattern of use of the medicine, depicting overuse of the analgesics, may pose irreversible harm to the medicine users and the community at large. Interviewer-administered questionnaires were filled in by patients presenting with pain on consultation and clinicians in the city; and a tool to assess opioid prescription patterns was filled in at pharmacies where opiate analgesics are dispensed. The likelihood of overuse of opiate analgesics by patients in pain was computed and analyzed using logistic regression models in SPSS version 23 and factors influencing opiate analgesic overuse in the city. 365 patients were enrolled in the study, 243 (66.7%) of them were female and point prevalence of pain was established to be 39%. 61 clinicians participated in the study were, largely comprising nursing staff. Knowledge levels and perceptions of clinicians served as proxy for independent variables influencing opiate analgesic overuse. Variables that were mostly associated with patients’ likelihood to overuse opiate analgesics included: pain interference on sleep at [OR: 0.07(95% CI: 0.06-0.08)p<0.005] and pain interference with general activity at [OR: 0.06(95% CI: 0.05-0.08)p<0.005]. The average knowledge score of the clinicians with respect to perceptions and knowledge about opioid analgesics, was 52.3%. Factors that were most statistically significant in influencing opiate analgesic overuse were lack of availability and adherence to guidelines at [OR: 0.36(95% CI: 0.27-0.45) p<0.05] and inadequate training of clinicians at [OR: 0.12(95% CI: 0.04-0.19) p< 0.05]. Clinicians’ prescribing patterns indicated typical length of opiate analgesics for treatment of chronic pain to be more than the seven-day recommended dosing. The researcher recommends a longer prospective study, conducted at more sites nationwide such that the results thereof can be generalized. Furthermore, in-depth training of all clinicians on associated benefits and risks of opioids and alternatives will contribute greatly in mitigating opiate analgesic overuse.