This document contains information from multiple studies on opioid use and prescribing trends: - A national survey from 1997-2007 found increases in opioid prescribing rates, with the highest rates (over 80 prescriptions per 100 persons) seen in those aged 61-80. - Cohort and longitudinal studies from multiple countries showed increases in defined daily doses of opioids like morphine, codeine, and pethidine from the late 1980s through early 2000s. - Studies analyzed trends in prescribing of different classes of pain medications like opioids, NSAIDs, and acetaminophen alone or in combination.

1. 1997 2007

3. 3

5. 80+
61-80
<20
21-60

6. 6

7. N= 1,172,115 23 =
(national survey)
(population-based) (Cohort analysis)
... (longitudinal study)

8. A school of fishes is not yours
8

9. it depends on how you are fishing!
8

10. Defined Daily Dose (DDD)
Opioids DDD
morphine= 30 mg
pethidine=100 mg
codeine=400 mg
9

11. 300 pethidine
codeine
225 morphine
1987-2002
150
75
0
1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

12. 1,891
Italy
121
1,892 total DDD
Taiwan
168 morphine DDD
4,550
Germany
574 1994-1998
27,942
Switzerland
1,763
27,748
UK
2,569
29,701
Denmark
6,993
39,316
Ireland
2,454
0 8,000 16,000 24,000 32,000 40,000
defined daily dose/million

17. COX2 NSAID Acetaminophen

23. I
Pethidine
Tramadol Morphine Fentanyl
NSAID ketorolac

25. III
NSAID ketorolac
non-ketorolac
45

32. II
opioid NSAID
NSAID
opioid
ketorolac non-
ketorolac

36. IV
2003 2004

37. 1997 2007
36

38. Paradox I

39. Paradox I

40. Paradox II

41. Paradox II

45. 41