Determinants of prescription opioid use: population-based evidence from Finland

Background and aims Previous studies have shown that prescription opioid use is more common in socio-economically disadvantaged communities in the United States. This study examined the area and individual-level determinants of prescription opioid use in Finland during the period 1995-2016. Design Logistic regression analysis using nation-wide data on filled opioid-related prescriptions dispensed at Finnish pharmacies and covered by National Health Insurance. Opioid consumption was linked, using personal identification codes, to population-based data maintained by Statistics Finland, which records individual background and area-level characteristics. Setting and participants Working-age population aged between 15 and 64 years in Finland during the periods 1995-2007 (n = 4 315 409) and 2009-16 (n = 4 116 992). Measurements Annual prescription opioid use was measured using defined daily doses (DDD) and whether people used opioids during a year. Findings Prescription opioid use increased in Finland from 1995 to 2016 (from less than 1 to 7%), but the increase was explained by the change in the treatment of codeine-based opioids in National Health Insurance. The area-level unemployment rate was positively correlated with the share of opioid users at the municipal level (r = 0.36; P < 0.001). In comparison with being employed, being outside the labour force was associated with increased opioid use in 1995-2007 [odds ratio (OR) = 2.22, 95% confidence interval (CI) = 2.10-2.36] and non-codeine opioid use in 2009-16 (OR = 2.16, 95% CI = 2.06-2.27), but not with codeine opioid use in 2009-16. Conclusions Prescription opioid use in Finland appears to be more common among low socio-economic status people, similar to the United States and the United Kingdom.

Automated summary

Prescription opioid use in Finland increased from 1995 to 2016, primarily due to changes in the treatment of codeine-based opioids under National Health Insurance. The study found a positive correlation between area-level unemployment rate and the percentage of opioid users at the municipal level, and an association between being outside the labour force and increased opioid use.