This indicator shows the number and rate per 1,000 of the PHO-enrolled population who had a strong opioid dispensed to them by a community pharmacy over six weeks or more, between 2019 and 2023.
A ‘strong’ opioid is classed as step 3 of the World Health Organization’s (WHO) analgesic ladder. This includes fentanyl, methadone, morphine, oxycodone and pethidine. These opioids are subsidised in New Zealand.
The Institute for Healthcare Improvement (IHI) classifies opioids as one of four groups of medicines (along with anticoagulants, insulin and sedatives) that can cause harm to patients, even when used as intended. Except in some circumstances, strong opioids are intended for short-term use only, with use for six weeks or more raising questions of appropriateness.
PHO-enrolled population who were dispensed a strong opioid for 6–12 weeks after the first dispensing during the calendar year.
Numerator detail
Date between first dispensing in a year and any subsequent dispensing to be greater than or equal to six weeks and not more than 12 weeks.
Only dispensings in the same calendar year were included. The year was truncated at mid-November, ie, first dispensings from mid-November to 31 December were excluded as they would not meet the criteria of a subsequent dispensing 6–12 weeks after the first.
Medications: 1274 Fentanyl citrate; 1795 Methadone hydrochloride; 1830 Morphine hydrochloride; 1831 Morphine sulphate; 2383 Morphine tartrate; 3801 Fentanyl; 3822 Oxycodone hydrochloride; 3896 Fentanyl citrate; 1953 Pethidine hydrochloride
Numerator exclusions
Opioid substitution treatment was excluded by identifying people dispensed methadone every first, second or third day.
Methadone for opioid substitution treatment was excluded from this indicator by removing records dispensed methadone within three days of the previous dispensing.
PHO-enrolled population during the calendar year
Disaggregation
District analysis: By year (2019 –2023), age group (0–24, 25–64; 65–79 and 80 and over), gender (female, male), ethnic group (Māori, Pacific peoples, Asian and European/Other) and Health New Zealand district of domicile.
PHO analysis: By year (2023), age group, gender, ethnic group, Primary Health Organisation (PHO) most recently enrolled with (for the relevant year), PHO group (small, medium, medium-large and large).
People who were excluded from the analysis were:
- individuals with missing demographics– that is, those with no recorded value for one or more of the National Health Index (NHI) fields used to derive the demographic variables of interest (age, gender, ethnicity and district of domicile). For instance, a person with no recorded ethnicity in 2023 is excluded from all indicators for that calendar year. This approach ensures a consistent denominator throughout the analyses.
- those who weren’t enrolled in a PHO in the calendar year.
Data is not presented where the number of people in the numerator was less than 10. This is to preserve confidentiality.
Age group is assigned using 30 June of each calendar year as the cutoff point. For example, a person turning 65 years old on 30 June 2023 will be assigned to the 65–79 years age group for 2023, while a person turning 65 on 1 July 2023 will be assigned the 25–64 group for the same year.
Unlike other atlases, the Opioid Atlas includes individuals who died during the calendar year in all indicators. This is because opioid use is higher among older adults and those in the final stages of life, due to chronic conditions, pain management, and palliative care needs. Including them ensures a complete and accurate picture of opioid exposure.