International Trends in Opioid Prescribing by Age and Sex from 2001 to 2019: An Observational Study Using Population-Based Databases from 18 Countries and One Special Administrative Region

Adrienne Y. L. Chan; Shahram Bahmanyar; Kebede Beyene; Greta Bushnell; Bruce Carleton; Amy Hai Yan Chan; Sharon Cook; Stephen Crystal; Kari Furu; Svetla Gadzhanova; Patricia García Poza; Rosa Gini; Sabrina Giometto; Jeff Harrison; Ulrike Haug; Christine Hsu; Harpa Lind Hjordisar Jonsdottir; Joe Kai; Øystein Karlstad; Ju Hwan Kim; Kiyoshi Kubota; Edward Chia-Cheng Lai; Hyesung Lee; Wallis C Y Lau; Kathy H. Li; Ersilia Lucenteforte; Géric Maura; Anke Neumann; Virginia Pate; Anton Pottegård; Nadeem Qureshi; Lotte Rasmussen; Johan Reutfors; Elizabeth E. Roughead; Leena Saastamoinen; Tsugumichi Sato; Oliver Scholle; C. C. M. Schuiling-Veninga; Chin-Yao Shen; Ju-Young Shin; Til Stürmer; Katja Taxis; Marco Tuccori; Stephen Weng; Kirstie H. T. W. Wong; Helga Zoega; Kenneth K. C. Man; Ian C. K. Wong

doi:10.1007/s40263-025-01215-2

International Trends in Opioid Prescribing by Age and Sex from 2001 to 2019: An Observational Study Using Population-Based Databases from 18 Countries and One Special Administrative Region

Adrienne Y. L. Chan, Shahram Bahmanyar, Kebede Beyene, Greta Bushnell, Bruce Carleton, Amy Hai Yan Chan, Sharon Cook, Stephen Crystal, Kari Furu, Svetla Gadzhanova, Patricia García Poza, Rosa Gini, Sabrina Giometto, Jeff Harrison, Ulrike Haug, Christine Hsu, Harpa Lind Hjordisar Jonsdottir, Joe Kai, Øystein Karlstad, Ju Hwan KimKiyoshi Kubota, Edward Chia-Cheng Lai, Hyesung Lee, Wallis C Y Lau, Kathy H. Li, Ersilia Lucenteforte, Géric Maura, Anke Neumann, Virginia Pate, Anton Pottegård, Nadeem Qureshi, Lotte Rasmussen, Johan Reutfors, Elizabeth E. Roughead, Leena Saastamoinen, Tsugumichi Sato, Oliver Scholle, C. C. M. Schuiling-Veninga, Chin-Yao Shen, Ju-Young Shin, Til Stürmer, Katja Taxis, Marco Tuccori, Stephen Weng, Kirstie H. T. W. Wong, Helga Zoega, Kenneth K. C. Man, Ian C. K. Wong

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Abstract

Objective: To characterize multinational trends and patterns of opioid analgesic prescribing by sex and age. Design, Setting, and Participants: We studied opioid analgesic prescribing from 2001 to 2019 with common protocol using population-based databases from eighteen countries and one special administrative region. Main Outcome Measures: We measured opioid prescribing by geographical region, sex and age, estimating annual prevalent, incident, and nonincident opioid prescribing per 100 population with a 95% confidence interval (CI) and meta-analyzed the multinational and regional opioid prescribing with a random-effects model. Time trends were reported through average annual absolute changes, estimated using linear mixed models. We further explored the effect of sex and age on prevalent opioid prescribing in the multivariable analysis. Results: Over 248 million individuals were included. Pooled multinational opioid prescribing prevalence was 9.0% amongst included countries/regions. Opioid prescribing prevalence in 2015 ranged from 2.7% in Japan to 19.7% in Iceland. Average annual absolute changes in opioid prescribing prevalence per year ranged from − 1.53% (95% CI − 2.06, − 1.00; United States Medicaid) to + 1.24% (95% CI 1.02, 1.46; South Korea). Pooled multinational incident opioid prescribing (4.9%; 95% CI 4.1, 5.9) was higher than pooled multinational nonincident opioid prescribing (3.7%; 95% CI 2.9, 4.8). The female sex and older age were associated with higher opioid prescribing. Main limitations of this study include the absence of data from study duration or individuals not covered by the data sources and the lack of information on medication adherence and indication. Conclusions: Opioid prescribing remains unbalanced across geographical regions; however, results suggest a tendency to convergence across countries/regions. Differences in opioid prescribing by sex and age were identified.

Original language	English
Pages (from-to)	1173-1185
Number of pages	13
Journal	CNS Drugs
Volume	39
Issue number	11
Early online date	1 Sept 2025
DOIs	https://doi.org/10.1007/s40263-025-01215-2
Publication status	E-pub ahead of print - 1 Sept 2025

Bibliographical note

Copyright © The Author(s) 2025. This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit https://creativecommons.org/licenses/by-nc/4.0/

Keywords

Adolescent
Adult
Age Factors
Aged
Analgesics, Opioid/therapeutic use
Databases, Factual
Drug Prescriptions/statistics & numerical data
Female
Humans
Internationality
Male
Middle Aged
Practice Patterns, Physicians'/trends
Sex Factors
Young Adult

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10.1007/s40263-025-01215-2Licence: CC BY-NC 4.0

AYL Chan et al_International Trends in Opioid Prescribing by Age and Sex_2001 to 2019_Observational Study Using Population-Based Databases from 18 Countries and 1 SAR
Copyright © The Author(s) 2025. This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. To view a copy of this licence, visit https://creativecommons.org/licenses/by-nc/4.0/
Final published version, 1.31 MBLicence: CC BY-NC 4.0

Cite this

Chan, A. Y. L., Bahmanyar, S., Beyene, K., Bushnell, G., Carleton, B., Chan, A. H. Y., Cook, S., Crystal, S., Furu, K., Gadzhanova, S., García Poza, P., Gini, R., Giometto, S., Harrison, J., Haug, U., Hsu, C., Jonsdottir, H. L. H., Kai, J., Karlstad, Ø., ... Wong, I. C. K. (2025). International Trends in Opioid Prescribing by Age and Sex from 2001 to 2019: An Observational Study Using Population-Based Databases from 18 Countries and One Special Administrative Region. CNS Drugs, 39(11), 1173-1185. Advance online publication. https://doi.org/10.1007/s40263-025-01215-2

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title = "International Trends in Opioid Prescribing by Age and Sex from 2001 to 2019: An Observational Study Using Population-Based Databases from 18 Countries and One Special Administrative Region",

abstract = "Objective: To characterize multinational trends and patterns of opioid analgesic prescribing by sex and age. Design, Setting, and Participants: We studied opioid analgesic prescribing from 2001 to 2019 with common protocol using population-based databases from eighteen countries and one special administrative region. Main Outcome Measures: We measured opioid prescribing by geographical region, sex and age, estimating annual prevalent, incident, and nonincident opioid prescribing per 100 population with a 95% confidence interval (CI) and meta-analyzed the multinational and regional opioid prescribing with a random-effects model. Time trends were reported through average annual absolute changes, estimated using linear mixed models. We further explored the effect of sex and age on prevalent opioid prescribing in the multivariable analysis. Results: Over 248 million individuals were included. Pooled multinational opioid prescribing prevalence was 9.0% amongst included countries/regions. Opioid prescribing prevalence in 2015 ranged from 2.7% in Japan to 19.7% in Iceland. Average annual absolute changes in opioid prescribing prevalence per year ranged from − 1.53% (95% CI − 2.06, − 1.00; United States Medicaid) to + 1.24% (95% CI 1.02, 1.46; South Korea). Pooled multinational incident opioid prescribing (4.9%; 95% CI 4.1, 5.9) was higher than pooled multinational nonincident opioid prescribing (3.7%; 95% CI 2.9, 4.8). The female sex and older age were associated with higher opioid prescribing. Main limitations of this study include the absence of data from study duration or individuals not covered by the data sources and the lack of information on medication adherence and indication. Conclusions: Opioid prescribing remains unbalanced across geographical regions; however, results suggest a tendency to convergence across countries/regions. Differences in opioid prescribing by sex and age were identified.",

keywords = "Adolescent, Adult, Age Factors, Aged, Analgesics, Opioid/therapeutic use, Databases, Factual, Drug Prescriptions/statistics & numerical data, Female, Humans, Internationality, Male, Middle Aged, Practice Patterns, Physicians'/trends, Sex Factors, Young Adult",

author = "Chan, {Adrienne Y. L.} and Shahram Bahmanyar and Kebede Beyene and Greta Bushnell and Bruce Carleton and Chan, {Amy Hai Yan} and Sharon Cook and Stephen Crystal and Kari Furu and Svetla Gadzhanova and {Garc{\'i}a Poza}, Patricia and Rosa Gini and Sabrina Giometto and Jeff Harrison and Ulrike Haug and Christine Hsu and Jonsdottir, {Harpa Lind Hjordisar} and Joe Kai and {\O}ystein Karlstad and Kim, {Ju Hwan} and Kiyoshi Kubota and Lai, {Edward Chia-Cheng} and Hyesung Lee and Lau, {Wallis C Y} and Li, {Kathy H.} and Ersilia Lucenteforte and G{\'e}ric Maura and Anke Neumann and Virginia Pate and Anton Potteg{\aa}rd and Nadeem Qureshi and Lotte Rasmussen and Johan Reutfors and Roughead, {Elizabeth E.} and Leena Saastamoinen and Tsugumichi Sato and Oliver Scholle and Schuiling-Veninga, {C. C. M.} and Chin-Yao Shen and Ju-Young Shin and Til St{\"u}rmer and Katja Taxis and Marco Tuccori and Stephen Weng and Wong, {Kirstie H. T. W.} and Helga Zoega and Man, {Kenneth K. C.} and Wong, {Ian C. K.}",

note = "Copyright {\textcopyright} The Author(s) 2025. This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit https://creativecommons.org/licenses/by-nc/4.0/",

year = "2025",

month = sep,

day = "1",

doi = "10.1007/s40263-025-01215-2",

language = "English",

volume = "39",

pages = "1173--1185",

journal = "CNS Drugs",

number = "11",

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Chan, AYL, Bahmanyar, S, Beyene, K, Bushnell, G, Carleton, B, Chan, AHY, Cook, S, Crystal, S, Furu, K, Gadzhanova, S, García Poza, P, Gini, R, Giometto, S, Harrison, J, Haug, U, Hsu, C, Jonsdottir, HLH, Kai, J, Karlstad, Ø, Kim, JH, Kubota, K, Lai, EC-C, Lee, H, Lau, WCY, Li, KH, Lucenteforte, E, Maura, G, Neumann, A, Pate, V, Pottegård, A, Qureshi, N, Rasmussen, L, Reutfors, J, Roughead, EE, Saastamoinen, L, Sato, T, Scholle, O, Schuiling-Veninga, CCM, Shen, C-Y, Shin, J-Y, Stürmer, T, Taxis, K, Tuccori, M, Weng, S, Wong, KHTW, Zoega, H, Man, KKC & Wong, ICK 2025, 'International Trends in Opioid Prescribing by Age and Sex from 2001 to 2019: An Observational Study Using Population-Based Databases from 18 Countries and One Special Administrative Region', CNS Drugs, vol. 39, no. 11, pp. 1173-1185. https://doi.org/10.1007/s40263-025-01215-2

International Trends in Opioid Prescribing by Age and Sex from 2001 to 2019: An Observational Study Using Population-Based Databases from 18 Countries and One Special Administrative Region. / Chan, Adrienne Y. L.; Bahmanyar, Shahram; Beyene, Kebede et al.
In: CNS Drugs, Vol. 39, No. 11, 01.09.2025, p. 1173-1185.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - International Trends in Opioid Prescribing by Age and Sex from 2001 to 2019: An Observational Study Using Population-Based Databases from 18 Countries and One Special Administrative Region

AU - Chan, Adrienne Y. L.

AU - Bahmanyar, Shahram

AU - Beyene, Kebede

AU - Bushnell, Greta

AU - Carleton, Bruce

AU - Chan, Amy Hai Yan

AU - Cook, Sharon

AU - Crystal, Stephen

AU - Furu, Kari

AU - Gadzhanova, Svetla

AU - García Poza, Patricia

AU - Gini, Rosa

AU - Giometto, Sabrina

AU - Harrison, Jeff

AU - Haug, Ulrike

AU - Hsu, Christine

AU - Jonsdottir, Harpa Lind Hjordisar

AU - Kai, Joe

AU - Karlstad, Øystein

AU - Kim, Ju Hwan

AU - Kubota, Kiyoshi

AU - Lai, Edward Chia-Cheng

AU - Lee, Hyesung

AU - Lau, Wallis C Y

AU - Li, Kathy H.

AU - Lucenteforte, Ersilia

AU - Maura, Géric

AU - Neumann, Anke

AU - Pate, Virginia

AU - Pottegård, Anton

AU - Qureshi, Nadeem

AU - Rasmussen, Lotte

AU - Reutfors, Johan

AU - Roughead, Elizabeth E.

AU - Saastamoinen, Leena

AU - Sato, Tsugumichi

AU - Scholle, Oliver

AU - Schuiling-Veninga, C. C. M.

AU - Shen, Chin-Yao

AU - Shin, Ju-Young

AU - Stürmer, Til

AU - Taxis, Katja

AU - Tuccori, Marco

AU - Weng, Stephen

AU - Wong, Kirstie H. T. W.

AU - Zoega, Helga

AU - Man, Kenneth K. C.

AU - Wong, Ian C. K.

N1 - Copyright © The Author(s) 2025. This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit https://creativecommons.org/licenses/by-nc/4.0/

PY - 2025/9/1

Y1 - 2025/9/1

N2 - Objective: To characterize multinational trends and patterns of opioid analgesic prescribing by sex and age. Design, Setting, and Participants: We studied opioid analgesic prescribing from 2001 to 2019 with common protocol using population-based databases from eighteen countries and one special administrative region. Main Outcome Measures: We measured opioid prescribing by geographical region, sex and age, estimating annual prevalent, incident, and nonincident opioid prescribing per 100 population with a 95% confidence interval (CI) and meta-analyzed the multinational and regional opioid prescribing with a random-effects model. Time trends were reported through average annual absolute changes, estimated using linear mixed models. We further explored the effect of sex and age on prevalent opioid prescribing in the multivariable analysis. Results: Over 248 million individuals were included. Pooled multinational opioid prescribing prevalence was 9.0% amongst included countries/regions. Opioid prescribing prevalence in 2015 ranged from 2.7% in Japan to 19.7% in Iceland. Average annual absolute changes in opioid prescribing prevalence per year ranged from − 1.53% (95% CI − 2.06, − 1.00; United States Medicaid) to + 1.24% (95% CI 1.02, 1.46; South Korea). Pooled multinational incident opioid prescribing (4.9%; 95% CI 4.1, 5.9) was higher than pooled multinational nonincident opioid prescribing (3.7%; 95% CI 2.9, 4.8). The female sex and older age were associated with higher opioid prescribing. Main limitations of this study include the absence of data from study duration or individuals not covered by the data sources and the lack of information on medication adherence and indication. Conclusions: Opioid prescribing remains unbalanced across geographical regions; however, results suggest a tendency to convergence across countries/regions. Differences in opioid prescribing by sex and age were identified.

AB - Objective: To characterize multinational trends and patterns of opioid analgesic prescribing by sex and age. Design, Setting, and Participants: We studied opioid analgesic prescribing from 2001 to 2019 with common protocol using population-based databases from eighteen countries and one special administrative region. Main Outcome Measures: We measured opioid prescribing by geographical region, sex and age, estimating annual prevalent, incident, and nonincident opioid prescribing per 100 population with a 95% confidence interval (CI) and meta-analyzed the multinational and regional opioid prescribing with a random-effects model. Time trends were reported through average annual absolute changes, estimated using linear mixed models. We further explored the effect of sex and age on prevalent opioid prescribing in the multivariable analysis. Results: Over 248 million individuals were included. Pooled multinational opioid prescribing prevalence was 9.0% amongst included countries/regions. Opioid prescribing prevalence in 2015 ranged from 2.7% in Japan to 19.7% in Iceland. Average annual absolute changes in opioid prescribing prevalence per year ranged from − 1.53% (95% CI − 2.06, − 1.00; United States Medicaid) to + 1.24% (95% CI 1.02, 1.46; South Korea). Pooled multinational incident opioid prescribing (4.9%; 95% CI 4.1, 5.9) was higher than pooled multinational nonincident opioid prescribing (3.7%; 95% CI 2.9, 4.8). The female sex and older age were associated with higher opioid prescribing. Main limitations of this study include the absence of data from study duration or individuals not covered by the data sources and the lack of information on medication adherence and indication. Conclusions: Opioid prescribing remains unbalanced across geographical regions; however, results suggest a tendency to convergence across countries/regions. Differences in opioid prescribing by sex and age were identified.

KW - Adolescent

KW - Adult

KW - Age Factors

KW - Aged

KW - Analgesics, Opioid/therapeutic use

KW - Databases, Factual

KW - Drug Prescriptions/statistics & numerical data

KW - Female

KW - Humans

KW - Internationality

KW - Male

KW - Middle Aged

KW - Practice Patterns, Physicians'/trends

KW - Sex Factors

KW - Young Adult

UR - https://link.springer.com/article/10.1007/s40263-025-01215-2

UR - http://www.scopus.com/inward/record.url?scp=105014777899&partnerID=8YFLogxK

U2 - 10.1007/s40263-025-01215-2

DO - 10.1007/s40263-025-01215-2

M3 - Article

C2 - 40889082

VL - 39

SP - 1173

EP - 1185

JO - CNS Drugs

JF - CNS Drugs

IS - 11

ER -

International Trends in Opioid Prescribing by Age and Sex from 2001 to 2019: An Observational Study Using Population-Based Databases from 18 Countries and One Special Administrative Region

Abstract

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Keywords

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