OBJECTIVES: The aim of this study was to evaluate the consumption of prescription narcotics (including morphine, fentanyl, meperidine, codeine, buprenorphine, tramadol and opium) covered by National Health Insurance in Taiwan during 2004-2013.

METHODS: Prescriptions and users of narcotics were identified from the Longitudinal Health Insurance Database. Narcotics consumption were calculated as defined daily dose (DDD) per 1,000 beneficiaries per day. In Taiwan, the Controlled Drugs Act divided all controlled substances into four categories based on their public harmfulness, drug addiction, and drug-abuse. We thus further categorized narcotics studied into schedule I, II, III and IV to see whether this categorization had impacts on the consumption. The impact of physician specialty on the consumption of narcotics in each categories was explored as well.

RESULTS: The total consumption of narcotics decreased from 32.71 DDD/1,000 beneficiaries/day in 2004 to 1.78 DDD/1,000 beneficiaries/day in 2009. These decrease may resulted in the abrupt decreases of schedule IV codeine, which decreased from 32.18 DDD/1,000 beneficiaries/day in 2004 to 0.85 DDD/1,000 beneficiaries/day in 2009. The safety-related regulations on codeine use in children released by Taiwan’s Food and Drug Administration and National Health Insurance Administrations may explain the changes. In contrast, we found a steady increase in the consumption of schedule I, II narcotics and tramadol from 2004 to 2013. The total consumption of narcotics increase from 1.78 DDD/1,000 beneficiaries/day in 2009 to 2.07 DDD/1,000 beneficiaries/day in 2013. Physician specialties varied in use of these narcotics. For example, oncologists accounted for the largest proportion of prescribers of fentanyl while orthopedics accounted for the largest proportion of prescribers of tramadol.

CONCLUSIONS: Our findings could serve as good references to help health professionals and public policy-makers to optimize the use of narcotics.