• D Ruiz-López and A Alonso-Babarro.
• Equipo de Soporte Paliativo Domiciliario (ESAPD), Centro de Salud Legazpi, Dirección Asistencial Noroeste de Atención Primaria, Servicio Madrileño de Salud, Madrid, España. Electronic address: diego.ruiz@salud.madrid.org.
• Rev Clin Esp. 2019 Oct 1; 219 (7): 367-374.

Background And ObjectivesOpioid consumption is an appropriate indicator of pain treatment. In Spain, there are scarcely any studies on the evolution of the consumption of opioids and their detailed use in the various settings.Material And MethodsWe conducted an analytical, observational, retrospective study of prescriptions performed in the Community of Madrid in all primary care and specialized care centres and the three major hospitals between 2004 and 2014 to determine the influence of the various departments on the prescription of opioids.ResultsOpioid consumption in Madrid between 2004 and 2014 increased more than 3-fold (2.67 vs. 8.10 defined daily doses/1000 inhabitants/day [DIDs] for 2004 and 2014, respectively).Tramadol was the most widely prescribed opioid (4.12 DIDs in 2014).Among the stepIII opioids, the most widely employed was fentanyl (1.23 DIDs in 2014). In primary care, the most prescribed stepIII opioids were fentanyl (0.92 DIDs in 2014), buprenorphine (0.31 DIDs in 2014), oxycodone (0.20 DIDs in 2014) and tapentadol (0.14 DIDs in 2014). In specialized care, the most prescribed opioids were fentanyl (0.05 DIDs in 2014), oxycodone (0.03 DIDs in 2014) and tapentadol (0.02 DIDs in 2014). In both cases, morphine represented a tiny percentage (0.12 primary care and 0.02 specialized care DIDs in 2014). Lastly, the most widely used opioid in the hospitals was morphine (0.38 DIDs in 2014), fentanyl (0.27 DIDs in 2014) and oxycodone (0.04 DIDs in 2014). For the palliative care teams (both home and hospital), the most consumed opioids were morphine (40-50% of the total) and methadone (35% of the total).ConclusionsThe overall consumption of opioids in Madrid tripled between 2004 and 2014. Tramadol and fentanyl were the most prescribed of the stepII andIII analgesics, respectively. The role of morphine is diminishing in the prescription of opioids.Copyright © 2019 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

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