• Tamar Freud, Michael Sherf, Erez Battat, Daniel Vardy, and Pesach Shvartzman.
• Division of Community Health, Department of Family Medicine, Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel. freudt@bgu.ac.il
• Isr Med Assoc J. 2013 Feb 1;15(2):89-93.

BackgroundOpioids are considered a cornerstone in the treatment of cancer pain.ObjectivesTo assess opioid use during a 6 year period (2001-2006) among cancer patients served by Clalit Health Services, the largest health management organization in Israel.MethodsPurchasing data of opioids authorized for use in Israel were obtained from the computerized databases of Clalit for the period 2001-2006. Patients' demographic and cancer morbidity data were extracted. The data were analyzed by translating the purchased opioids (fentanyl patch, oxycodone, buprenorphine, methadone, hydromorphone) to oral morphine equivalents (OME).ResultsDuring the study period 182,066 Clalit members were diagnosed with cancer; 58,443 (32.1%) of them died and 31,628 (17.3%) purchased opioids at least once. In 2001, 7.5% of Clalit cancer patients purchased opioids at least once within 5 years of the initial diagnosis. Between 2002 and 2006 this percentage increased consistently, reaching 9.9% in 2006. The average daily dose of opioids increased from 104.1 mg OME in the year 2001 to 115.2 mg OME in 2006 (11% increase). The average duration of opioid purchasing was 5.0 +/- 8.3 months (range 1-84 months, median 2). During the study period 19,426 cancer patients who purchased opioids at least once died; only 14.3% (3274) were still alive 2 years after their first opioid prescription.ConclusionsOpioid purchasing increased during the study period, especially during the final months of life. Children (0-18 years old) and elderly male patients (> or = 65 years) began opioid treatment later compared to other age groups. Only a few patients had an opioid early enough to relieve their pain.

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