[Analysis of pharmaceutical utilization data of strong opioids prescribed for baseline and breakthrough cancer pain...

In Hungary, the amount of strong opioids prescribed for cancer patients remains below that of Western countries, potentially leading to inadequate pain control. Although the World Health Organization recommends per os medication as first-line treatment, most patients receive transdermal fentanyl patches.

To analyze pharmaceutical utilization data of strong opioids prescribed for baseline and breakthrough cancer pain (2010-2024), and to examine regional prescribing patterns (2024).

Strong opioid dispensing data for cancer patients were analyzed at both national and county levels. Drug utilization was compared using oral morphine equivalent doses.

Between 2010 and 2024, total strong opioid utilization decreased to approximately two-thirds of its initial level. For baseline pain management, the use of transdermal fentanyl, transdermal buprenorphine, retard morphine tablets and hydromorphone tablets declined, while retard oxycodone tablet use increased. For breakthrough pain, morphine injections and oral morphine solution declined, whereas immediate-release morphine and oxycodone tablet use increased. In 2024, transdermal fentanyl accounted for 79.4% of total opioid use, prolonged-release oxycodone tablets for 16.7%, prolonged-release morphine tablets for 2.7%, and breakthrough pain medications for 1.25%. Regionally, transdermal fentanyl use was rather uniform, with lower proportions in Baranya County and Budapest. Prolonged-release morphine and oxycodone use showed marked regional variability, while breakthrough pain prescriptions were predominant in Baranya County.

Strong opioid utilization for cancer pain has declined over the past 15 years with fentanyl patches remaining dominant. Despite the high prevalence of breakthrough cancer pain, immediate-release opioids are minimally used. Barriers include insufficient knowledge among healthcare professionals, resulting in prescribing practices driven by local habits rather than clinical guidelines; closer adherence to guidelines is observed in regions with well-organized palliative care services.

Improved integration of palliative care services, targeted education of healthcare professionals, continuous drug availability and simplified prescribing procedures may enhance cancer pain management. Orv Hetil. 2026; 167(11): 419-429.