Chun-Ji Lin, Chia-Shuan Chang, Chih-Yi Wu, Jiun-Yi Wang, I-Ching Lin, Hung-Yi Chiou
Reimbursed analgesic prescribing in Taiwan has diverged across drug classes, with a consistent increase in opioid prescribing across all ages and a shift toward NSAID prescribing in younger populations. These claims-based trends should be interpreted as reimbursed prescribing rather than total analgesic use. These findings may inform targeted pharmacovigilance and policies to ensure appropriate pain management while mitigating potential opioid-related risks.
BACKGROUND: Despite ongoing global changes in analgesic prescribing practices, long-term trends accounting for age, period, and cohort effects remain poorly understood in Asian populations, where opioid and nonopioid prescribing trajectories differ from those observed in Western nations.
OBJECTIVE: This study aimed to examine the long-term prescribing trends of opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and paracetamol in Taiwan by age, calendar period, and birth cohort using an age-period-cohort (APC) framework.
METHODS: We conducted a population-based repeated cross-sectional study using Taiwan National Health Insurance claims data (2001-2020). The cohort included all insured individuals aged 1 to 85 years, with an annual population size of 22.3 to 23.1 million. Exposure variables were structured for APC modeling, comprising 5-year age groups, four 5-year calendar periods (2001-2020), and 5-year birth cohorts (1920-1924 to 2015-2019).
RESULTS: Opioid prescribing prevalence escalated from 123.66 per 100,000 persons in 2001 to 2005 to 706.93 in 2016 to 2020. APC analysis showed a significant positive net drift for opioids (+10.93% per year, 95% CI 10.36%-11.51%; P<.001). The estimated magnitude of the opioid prescribing increase was sensitive to the prescription frequency threshold used. In contrast, paracetamol and NSAIDs showed overall declines (net drifts: -2.44%, 95% CI -2.58% to -2.29%, and -0.82%, 95% CI -0.97% to -0.66%, respectively). Notably, local drifts revealed a significant increase in NSAID prescribing only among adolescents aged 11 to 15 years (+0.80% per year, 95% CI 0.34%-1.27%). Generational analysis suggested higher opioid prescribing risk among younger cohorts (rate ratios 3.06 for the 2015-2019 cohort), although the increase relative to the 2000 to 2004 reference cohort was not statistically significant.
CONCLUSIONS: Reimbursed analgesic prescribing in Taiwan has diverged across drug classes, with a consistent increase in opioid prescribing across all ages and a shift toward NSAID prescribing in younger populations. These claims-based trends should be interpreted as reimbursed prescribing rather than total analgesic use. These findings may inform targeted pharmacovigilance and policies to ensure appropriate pain management while mitigating potential opioid-related risks.