Background: Oxycodone (OXY) and morphine (MÔ) are frequently used in hospitals. OXY consumption has been increasing in Switzerland since the 2000s. Even before the merging of Chablais and Riviera hospitals, the Riviera-Chablais Hospital, Vaud-Valais (HRC) tends to favor the use of MÔ and to support it as the first strong-opiate choice as recommended in international guidelines. The move to a unique hospital in Rennaz in 2019 was the opportunity to assess this opiates consumption in order to promote good prescriptions practices.
Objective: To identify HRC wards that are major consumers of OXY compared to MÔ from 2016 to 2021.
Method: Data were extracted from the OpalTM logistics software. Wards included orthopedics (ORT), internal medicine (MED), surgery (SUR), geriatrics/rehabilitation (GER) and intensive care units (ICU). Total orders in absolute value of pharmaceutical specialty units of each opiate were cumulated per year and each time an OXY/MÔ ratio was calculated. For period 2016-2019, data on the different sites are cumulative. Year 2021 only takes into account the known statistics until March 1st. It is assumed that the number of units ordered is equal to the number of units consumed.
Results: All dosage forms combined, ORT (ratios vary between 2.93 and 7.95) and SUR (0.43-1.60) favor OXY; conversely, ICU (0.02-0.22), GER (0.30-0.58) and MED (0.27-0.59) favor MÔ. By taking into account only oral forms, MED also tends to favor OXY (0.75-4.52) but GER and ICU still consume more oral MÔ. Between 2018 and 2020, OXY consumption has increased in all wards (global rise 108.4%). The importance of injectable forms of MÔ in statistics may bias the overview OXY/MÔ ratios since there is no available OXY injectable form. Period 2019-2020 seems to be particular for all wards, especially for ICU, and many factors may contribute to it including the move to Rennaz, the growth of OXY consumption by outpatients, the COVID-19 pandemic or some long-staying patients. It seems difficult to attribute the variations in consumption statistics solely to one of these important coincidental events.
Conclusion: An upward trend in the oral OXY/MÔ ratio seems to emerge for SUR, MED and GER wards, showing the important and growing place of OXY in physician’s prescription habits. A change in the coming years can be expected thanks to HRC ERAS protocols that explicitly recommend MÔ use and to the development of analgesic teaching to physicians and nurses.