[Regional variations in opioid prescribing across Sweden's 21 counties]

The Swedish Board of Health and Welfare holds a statistical database with aggregated data on all dispensed prescription drugs in Swedish pharmacies since 2006. In this study, regional variations in opioid prescribing were analyzed by looking at yearly prevalence data for Sweden's 21 counties, focusing on 7 major medical opioids used in Sweden in 2024: buprenorphine (N02AE01), fentanyl (N02AB03), codeine (N02AJ06), morphine (N02AA01), oxycodone-naloxone (N02AA55), oxycodone (N02AA05), and tramadol (N02AX02). Principal component analysis was used to find patterns in the data. The yearly prevalence of overall opioid use in Sweden has declined from roughly 8 percent of the population in 2006-2016 to 6 percent in 2024. However, substantial geographic differences were identified in 2024. Two counties showed a relatively high prescribing of codeine and morphine. By contrast, while oxycodone dominated prescribing in all counties, 14 counties were characterized by a very high use of oxycodone, and some of them also by a high use of oxycodone-naloxone. Overall, the magnitude of inter-county differences was striking. For example, the oxycodone to morphine ratio was more than 15:1 in Södermanland compared with approximately 1:1 in Jämtland. It seems unlikely that these differences can be explained solely by sociodemographic differences. Instead, this suggests the presence of distinct regional treatment traditions. The study does not evaluate indications, treatment duration, or sociodemographic confounders. Nevertheless, the findings raise important questions about clinical reasoning, local prescribing cultures, and the need for further research to understand the drivers behind Sweden's pronounced regional variations in opioid prescribing.