Sixteen-Year Trend of Morphine Consumption in Taiwan: An International Comparison

Abstract

癌症疼痛治療一直是全世界亟待解決的重要問題之一，為了改善癌症疼痛治療，世界 衛生組織將嗎啡消耗量當作一個國家癌症疼痛緩解成效的指標。本文是根據中華民國 行政院衛生署管制藥品管理局與聯合國國際麻醉藥品管制局所提供的統計資料，對台 灣與各國嗎啡消耗量作一個回顧的分析。根據資料顯示，我國1987年的嗎啡消耗量以 每百萬人口DDD計算為12.2毫克，2002年則大幅升為257.7毫克，總計在16年間共成長 了20倍，平均每日嗎啡消耗量為丹麥的28分之1，為美國的12分之１。口服嗎啡從 1989年起就開始成長，至1999年開始趨緩，除了這段期間吩塔尼止痛貼片使用量激增 的原因之外，台灣地區的嗎啡普及化尚未達到滿意的程度前，卻已經步上歐美低成長 的模式，也是重要的因素。注射劑型在1995後開始快速的成長。雖然口服嗎啡消耗量 是癌症疼痛治療的重要指標，然而注射嗎啡的成長數據，亦可以充分呈現我國近年來 在治療急性疼痛上的進步的軌跡。Undertreatment of cancer pain has been a worldwide medical dilemma despite the introduction of three-step analgesic ladder by world health Organization (WHO) in 1982. For decades, morphine consumption has been proposed by WHO as an index for cancer pain management. In the review we compared morphine consumption in Taiwan with other countries based on the statistics of the National Bureau of Controlled Drugs of Taiwan and the International Narcotics Control Board of United Nations (INCB). We found that the ratios of average daily morphine consumption in Taiwan are 1 to 28 against Denmark and 1 to 12 against the United States. Similar patterns of low morphine consumption are found in other Asian countries, such as Hong Kong, Singapore, And Korea. Although morphine consumption has 20-fold increase from 1987 to 2002, we notice that oral morphine reached a plateau since 1997. Meanwhile , injectable morphine started to escalate since 1997 and continues to grow as a result of widespread establishment of acute pain service. We recommend that oral morphine, but not total morphine consumption, is a better indicator for cancer pain management while injectable morphine consumption can serve as an ideal indicator for acute pain service.